J Cancer 2020; 11(13):4000-4006. doi:10.7150/jca.41472

Research Paper

Diagnostic Yield and Performance of a Large Population-Based Cervical Cancer Screening Program in High-Risk Rural China

Zhilian Wang1, Tiannan Wang2*, Jing Yang1, Wei Wang1, Lili Zhang1, Xiaoqiang Su1, Zhe Wang1, Haitao Zhang1, Jinghui Song3, Weiguo Lv4, Jintao Wang5, Chen Wang6, Chengquan Zhao2, Min Hao1*✉

1. Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, China.
2. Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center. 300 Halket St, Pittsburgh, PA, USA.
3. Department of Obstetrics and Gynecology, Affiliated Hospital of InnerMongolia Medical University, Huhhot, China.
4. Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
5. Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China.
6. Department of Pathology, the Second Hospital of Shanxi Medical University, Taiyuan, China.
*Co-first author

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Wang Z, Wang T, Yang J, Wang W, Zhang L, Su X, Wang Z, Zhang H, Song J, Lv W, Wang J, Wang C, Zhao C, Hao M. Diagnostic Yield and Performance of a Large Population-Based Cervical Cancer Screening Program in High-Risk Rural China. J Cancer 2020; 11(13):4000-4006. doi:10.7150/jca.41472. Available from https://www.jcancer.org/v11p4000.htm

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Primary cervical cancer screening by liquid-based cytology alone or with adjunctive HPV testing are available worldwide. However, little if any information is available about cervical cancer diagnostic yield of population-based cervical cancer screening in China. In response to it, we conducted a large prospective study on 40,000 women cervical cancer screening within six-month period in rural Shanxi Province, where has been reported as the highest cervical cancer rates in China. A standard cross-sectional survey by self-completed questionnaire was collected and followed by the liquid-based cytology screening. Follow-up biopsy with the diagnosis of cervical intraepithelial neoplasia 2 or higher lesion (CIN2+) were analyzed. Of initial 40,000 women participating in this study, 6.76% (2702/40,000) women had ASC-US or higher cytology screening results with ASC/SIL ratio at 6.14 (2381:388). Among them, 1.96% (782/40,000) women were found CIN lesions (95% CI, 1.68-2.23%) on confirmatory biopsies, including 0.55% (218/40,000) CIN2+ and 19 SCCa (47.5/100,000, 95% CI, 29-74/100,000). Women in Yangqu County had lower ASC/SIL ratio, but higher CIN2+ detection rate in comparison with that of Jiexiu County (6.69 vs. 8.84 and 56.7% vs. 43.9%), which reflects the cervical cancer distribution in different populations and regions. Analysis in age-stratified cytology results indicated women aged 60-65 years had the highest incidence of cytologic abnormality among all the age group; likewise, women aged >50 years were at higher risk in developing cervical high grade dysplasia or cancer than women aged <50 years (0.82% vs. 0.49%). This large-scale cervical cancer screening study provided important references as the instructive for establishing the nation-wide cervical cancer screening strategy.

Keywords: Cervical cancer, Population based study, primary cytology screening, Cervical cancer diagnostic yield