Prevalence of cervical cancer and feasibility of screening in rural China: a pilot study for the Shanxi Province Cervical Cancer Screening Study

Abstract

For cervical cancer screening to be feasible in developing countries, it must be accurate, inexpensive, and easy to administer. We conducted a pilot study in rural Shanxi Province, People's Republic of China, to determine disease prevalence and study feasibility in preparation for a large-scale comparative trial of 6 screening tests. One-hundred and thirty-six nonpregnant women with no history of hysterectomy, pelvic radiation, or Papanicolaou tests were screened in a rural clinic. Ten percent of the women enrolled reported abnormal vaginal bleeding and 45% reported abnormal vaginal discharge. The tests were the Papanicolaou test (both conventional and ThinPrep), a self-administered swab test by Hybrid Capture II for high-risk human papillomavirus (HPV), a test for high-risk HPV from residual PreservCyt medium, fluorescence spectroscopy, and visual inspection of the cervix by a clinician. All women also underwent colposcopy and biopsies as the reference standard. Biopsies showed 12 of 136 women had >/= high-grade squamous intraepithelial lesions (HGSIL). Screening was completed in 5 half-day sessions, the procedures went smoothly, and local cooperation was enthusiastic. Disease prevalence in Xiangyuan and Yangcheng Counties, Shanxi Province, can be estimated at 8.8% (95% CI, 4.5% to 15.0%). Screening 1000-2000 patients would be sufficient to detect a 10% difference in accuracy between diagnostic tests. The proposed large-scale trial is feasible.

The probability for a Pap test to be abnormal is directly proportional to HPV viral load: results from a Swiss study comparing HPV testing and liquid-based cytology to detect cervical cancer precursors in 13 842 women

“…No HSIL was found in 502 biopsies from the HPVÀ/CYTOÀ subset. This is concordant with the Guanacaste study (Bratti et al, 2004: 0 HSIL out of 150) and the Shanxi study (Belinson et al, 1999(Dr R Gerald Pretorius, personal communication, January 2005: 0 HSIL out of 1274). In total, no HSIL was found in 1926 biopsies from HPVÀ/CYTOÀ subset.…”

“…Then, the number of abnormal cells per sample would be much more important and, consequently, the sensitivity gap between HPV and cytology for detection of HSIL would be much smaller. This idea is supported in the literature, as studies performed in a high-risk population demonstrated relatively small gaps (4, 10, 10 and 15%) (Belinson et al, 1999;Kuhn et al, 2000;Schiffman et al, 2000;Wright et al, 2000) compared with studies performed in a low-risk population with higher gaps (30, 38, 54 and 55%) (Ratnam et al, 2000;Clavel et al, 2001;Kulasingam et al, 2002;Petry et al, 2003).…”

“…After 50 years of cytology as the sole test in cervical cancer prevention, new methods are appearing to palliate the Achilles' heel of cytology, which is sensitivity. Indeed, many reports (Belinson et al, 1999;Kuhn et al, 2000;Ratnam et al, 2000;Schiffman et al, 2000;Wright et al, 2000;Clavel et al, 2001;Kulasingam et al, 2002;Petry et al, 2003) have established a higher sensitivity for HPV than for cytology, although published results are not unanimous (de Cremoux et al, 2003). The main study objective was to confirm the better sensitivity of HPV testing, especially in the context of routine clinical practice.…”

Efficacy of Pap Test in Combination with ThinPrep Cytological Test in Screening for Cervical Cancer

“…However, the TCT is costly as compared to the Pap test and requires specialized equipment and skilled personal, thus is application in clinical practice has been slow. Screening a large, rural population must take into consideration the sensitivity and specificity of the testing, ease of administration, and costs involved (Belinson et al, 1999). Although there have been a number of studies evaluating different methods and screening programs for cervical cancer in China, no ideal one has been identified (Belinson et al, 1999;Belinson et al, 2001;Belinson, 2002;Pan et al, 2003;Li et l., 2009).…”

“…The ThinPrep cytological test (TCT), a liquid-based method has been shown to have an increased sensitivity over that of the Pap test in screening for cervical cancer; however, it is more costly and requires specific equipment and specially trained personnel (Abulafa et al, Carns ey al., 2008). However, screening of very large numbers of individuals in a largely rural setting is associated with significant costs and logistical difficulties (Belinson et al, 1999;Belinson et al, 2001;Belinson, 2002;Pan et al, 2003;Li et al, 2009). Currently, the TCT has not been widely applied in China.…”