Conventional Pap Smear Cervical Cancer Screening in 11 Rural Counties in Hainan Province, China: Analysis of Bethesda System Reporting Rates for 218,195 Women (predominantly Ages 35-64 Years) Screened in China's National Cervical Cancer Screening Program in Rural Areas (NCCSPRA).

OBJECTIVE:Recently the Chinese government has introduced support for cervical screening in rural areas. The College of American Pathologists (CAP)-certified Guangzhou Kingmed Diagnostics laboratory supported rural screening program in Hainan Providence utilizing low-cost conventional Papanicolaou smears (CPS).STUDY DESIGN:This was a retrospective study of CPS screening results from 2011 to 2014 in 11 rural counties in Hainan Province. Women, most previously unscreened, volunteered to attend free CPS screening. The targeted population was women aged 35-65 years.RESULTS:Among total 218,195 conventional Papanicolaou smears, the reported abnormal rate was 4.4% of all smears, with 0.5% for high-grade squamous intraepithelial lesion (HSIL), 0.9% for low-grade squamous intraepithelial lesion (LSIL), 2.6% for atypical squamous cells of undetermined significance, and 0.3% for atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion. Reporting rates for different TBS categories were generally within CAP benchmark ranges, except for low reporting rates for unsatisfactory smears and for atypical glandular cells. Abnormal cytology rates varied among counties. Comparing different age groups, the LSIL rate was significantly higher in women <50 years than in women ≥50 years (1.04% versus 0.64%). The HSIL rate was significantly higher in women ≥40 years than in women <40 years (5.3% versus 0.38%). A total of 2286 women with abnormal Papanicolaou smears had documented colposcopic and histopathologic follow-up. Cervical cancer was diagnosed in 23 of 2286 (1.01%) of screened and biopsied patients. Histopathologic HSIL results were confirmed in 80% of biopsied women with HSIL Papanicolaou tests.CONCLUSIONS:CPS offered a low cost method to introduce cervical screening in rural China. The international College of American Pathologists Laboratory Accreditation Program provided laboratory quality control standards not otherwise readily available. Educational training programs have been instituted to address areas identified for quality improvement.