Analysis of cervical cancer screening results of 23 088 married women in Dongming County, Shandong Province

Abstract

Objective To analyze the cervical cancer screening results of married women in Dongming County of Shandong Province, and to provide scientific evidence for cervical cancer prevention in this region. Methods A retrospective study on the cytological results of 23 088 married women in Dongming County, from September 2016 to June 2017 was performed. Cervical swabs of 23 088 married women were referred to Jinan KingMed Diagnostics. The age of these married women is 19~90 years old. They were divided into 5 groups: 810 cases in group<30 years old, 5174 cases in group 30~39, 9301 cases in group 40~49, 5707 cases in group 50~59 and 2096 cases in group of over 60 years old. At the same time, 61 cases of high risk human papillomavirus (high-risk human papillomavirus, hrHPV) and 438 cases of abnormal cytology with tissue biopsy were followed up, and analyzed. Results A total of 1177 women (5.1%) were interpreted as cytological abnormalities, including 729 cases (3.2%) of atypical squamous cells of unknown significance (ASC-US), 43 cases (0.2%) of atypical squamous cells cannot exclude HSIL (ASC-H)/atypical glandular cells (AGC), 289 cases (1.3%) of low grade squamous intraepithelial lesions (LSIL), and 116 cases (0.5%) of high grade squamous intraepithelial lesions (HSIL). Of these cases with abnormal cytological results, 31 cases (50%) had hrHPV testing positive, and 200 cases (45.6%) had follow-up histological positive. The positive rates of ASC-US (χ2=5.502, P=0.019) and LSIL (χ2=3.956, P=0.047) significantly varied among different age groups. The highest positive rate of ASC-US was found in the 50~59 years old group (197 cases, 3.5%), while the lowest positive rate was found in the 30~39 years old group (134 cases, 2.6%). The highest positive rate of LSIL was observed in<30 (12 cases) and 30~39 (76 cases) years old groups (1.5% for both groups), while the lowest positive rate was observed in the 50~59 years old group (50 cases, 0.9%). Histopathologic follow-ups demonstrated obvious variations in different cytological results. Normal biopsy (χ2=113.536, P<0.001) accounted for the highest proportion in ASC-US (75.4%) and the lowest proportion in HSIL (9.8%); cervical intraepithelial neoplasia 1(CIN1) (χ2=37.817, P<0.001) was the most frequent in LSIL, but the least frequent in HSIL; CIN2/3/AIS/SCC (χ2=603.863, P<0.001) was the most common in HSIL but the least common in ASC-US. Significant variations in hrHPV testing were also observed in different cytological abnormalities (χ2=7.946, P=0.019) and different histopathologic results (χ2=3.925, P=0.048). The hrHPV-positive rates were 34.5%, 58.3% and 87.5% for ASC-US/ASC-H/AGC, LSIL and HSIL, respectively, and 37.5%, 60% and 75% for normal biopsy, CIN1 and CIN2/3/AIS/SCC, respectively. Conclusions The present study showed that cervical cytology screening can effectively detect cervical invasive cancer and its precancerous lesions. The severity of cytological abnormalities and the hrHPV-positive rates correlated well with the severity of histological abnormal findings. These results can provide a scientific basis for establishing cervical cancer screening strategies in this region. Key words: Cervical cancer; Cervical cytology; Screening; High-risk human papillomavirus