Since the People's Republic China founded,especially over the last 15 years,maternal mortality rate (MMR) has fallen dramatically.In 2014,China has achieved the target of a reduction of 75％ MMR from 1990 to 2015 (MDG5) ahead of schedule.This achievement can be attributed to the improvement of legislation and policy,government commitment and investment on maternal health,extensive international cooperation,implementation of the maternal health program,development of maternal and child health (MCH) service system and development of MCH surveillance systems.Although China has achieved MDG5,there are many kinds of difficulties and challenges in achieving the post-2015 Sustainable Development Goals (SDGs).Therefore,multi-strategy actions need to be considered to seize the opportunities to further reduce the MMR in the future.

Objective: To explore the epidemiologic characterization of high-risk human papillomavirus (HR-HPV) infection and genotype distribution of HR-HPV among women in rural areas of China. Methods: This study used multiple layers of stratified cluster random sampling method. During January to December in 2014, 117 counties of 27 provinces were selected as the HPV test screening pilot project counties. The women aged 35-64 years with rural areas Hukou in these project counties were selected as the study subjects. A total 457 799 women received HPV DNA test. Among them, 118 237 women from 32 counties in 11 provinces received qualified HPV DNA test by fluorescent PCR to detect HPV genotypes. Results: Among 118 237 rural women, the overall HR-HPV positive infection rate was 7.8% (9 249/118 237). The infection rate increased with age and reached an infection peak at the 60-64 age groups (9.9%, 831/8 394). The HR-HPV positive infection rate in western regions (6.9%, 2 144/31 130) was statistical significantly lower than in central regions (8.2%, 1 894/23 023) and eastern regions (8.1%, 5 211/64 084) (χ²=51.46, P<0.001). Among 9 249 women with specific genotypes of HR-HPV, 6 496 (97.6%) cases were infected with single HR-HPV type, and 163 cases (2.4% ) were infected with multiple types. HR-HPV type 52, 16 and 58 were the most common infection types in rural areas of China. The single infection rates were 20.9% (1 355/6 496), 18.7% (1 215/6 496), and 11.2% (725/6 496), respectively. The multiple infection rates were 47.2% (77/163), 17.8% (29/163), and 18.4% (30/163), respectively. Conclusion The HR-HPV positive infection rate in rural areas of Chinese woman was 7.8%, western region has lower infection rate compared with central and eastern regions. HPV 52 was first of the most common genotypes in rural areas of China.

Objective:To evaluate the effectiveness and quality of ultrasound-based (BUS) process optimization in breast cancer screening.Methods:The program collected the first to fourth quarterly breast cancer screening statistic data and case report data from 30 provinces, autonomous regions and municipalities in 2015 by the online report system of national key service program of women and children′s public health. The call rate, mammography (MG) subsequent screen rate, biopsy rate, detection rate, early diagnosis rate, carcinoma in situ rate, missing detection rate, false positive rate and positive predictive value (PPV) of breast cancer were calculated.Results:A total of 1 501 753 rural women attended the BUS process optimization screening. The nationwide recall rate was 3.01%(45 156/1 501 753), and in the eastern and central area were 3.41%(17 173/503 130) and 3.56%(14 499/407 739), respectively, higher than 2.28% (13 484/590 884) of western area ( P<0.05). The nationwide MG subsequent screen rate was 2.78%(41 694/1 501 753), and in the eastern and central area were 3.19%(16 036/503 130) and 3.29% (13 421/407 739), respectively, higher than 2.07%(12 237/590 884) of western area ( P<0.05). The nationwide biopsy rate was 0.23%(3 462/1 501 753), and in the central area were 0.26%(1 078/407 739), respectively, higher than 0.21%(1 247/590 884) of western area and 0.23% (1 137/503 130) of eastern area ( P<0.05). The nationwide biopsy PPV was 37.00%(1 281/3 462). The biopsy PPV of eastern area was (34.30%, 390/1 137), lower than 39.33% (424/1 078) of central area ( P<0.05). A total of 1 281 cases of breast cancer were detected, the detection rate was 0.85‰(1 281/1 501 753), and the detection rates of central area was 1.04‰ (424/407 739), higher than 0.79‰(467/590 884) of western area and 0.78‰(390/503 130) of eastern area ( P<0.05). The BUS initiate screening positive rate from detected breast cancer cases was 96.96%(1 242/1 281), the MG subsequent screening positive rate was 2.42%(31/1 281). The nationwide early diagnosis rate was 85.25%(1 092/1 281), and in the eastern and central areas were 87.95%(343/390) and 88.21%(374/424), higher than 80.30%(375/467) of western area ( P<0.05). The screening rate of on or above stage Ⅱ breast cancer in eastern area was 55.64%(217/390), lower than 64.62%(374/424) of central area and 62.31%(291/467) of western area. The missing detection rate was 0.62%(8/1 281) and false positive rate was 1.20%(17 528/1 464 149). Conclusions:The BUS process optimization of breast cancer screening scheme is reasonable and applicable to China rural women. The effectiveness and quality of eastern area are superior to those of central and western area.

Objective:To evaluate the effectiveness and quality of ultrasound-based (BUS) process optimization in breast cancer screening.Methods:The program collected the first to fourth quarterly breast cancer screening statistic data and case report data from 30 provinces, autonomous regions and municipalities in 2015 by the online report system of national key service program of women and children′s public health. The call rate, mammography (MG) subsequent screen rate, biopsy rate, detection rate, early diagnosis rate, carcinoma in situ rate, missing detection rate, false positive rate and positive predictive value (PPV) of breast cancer were calculated.Results:A total of 1 501 753 rural women attended the BUS process optimization screening. The nationwide recall rate was 3.01%(45 156/1 501 753), and in the eastern and central area were 3.41%(17 173/503 130) and 3.56%(14 499/407 739), respectively, higher than 2.28% (13 484/590 884) of western area ( P<0.05). The nationwide MG subsequent screen rate was 2.78%(41 694/1 501 753), and in the eastern and central area were 3.19%(16 036/503 130) and 3.29% (13 421/407 739), respectively, higher than 2.07%(12 237/590 884) of western area ( P<0.05). The nationwide biopsy rate was 0.23%(3 462/1 501 753), and in the central area were 0.26%(1 078/407 739), respectively, higher than 0.21%(1 247/590 884) of western area and 0.23% (1 137/503 130) of eastern area ( P<0.05). The nationwide biopsy PPV was 37.00%(1 281/3 462). The biopsy PPV of eastern area was (34.30%, 390/1 137), lower than 39.33% (424/1 078) of central area ( P<0.05). A total of 1 281 cases of breast cancer were detected, the detection rate was 0.85‰(1 281/1 501 753), and the detection rates of central area was 1.04‰ (424/407 739), higher than 0.79‰(467/590 884) of western area and 0.78‰(390/503 130) of eastern area ( P<0.05). The BUS initiate screening positive rate from detected breast cancer cases was 96.96%(1 242/1 281), the MG subsequent screening positive rate was 2.42%(31/1 281). The nationwide early diagnosis rate was 85.25%(1 092/1 281), and in the eastern and central areas were 87.95%(343/390) and 88.21%(374/424), higher than 80.30%(375/467) of western area ( P<0.05). The screening rate of on or above stage Ⅱ breast cancer in eastern area was 55.64%(217/390), lower than 64.62%(374/424) of central area and 62.31%(291/467) of western area. The missing detection rate was 0.62%(8/1 281) and false positive rate was 1.20%(17 528/1 464 149). Conclusions:The BUS process optimization of breast cancer screening scheme is reasonable and applicable to China rural women. The effectiveness and quality of eastern area are superior to those of central and western area.

Objective To analyze the reported data of national rural cervical cancer screening project from 2012 to 2013 and to evaluate the project implementation condition. Methods Data of the national breast carcinoma and cervical cancer (two-cancer) screening project for rural women were collected from the online report system of key women and children's public health service programs.The screening items included: preliminary screening of cervical lesions (cervical cytology, using Traian Bethesda System (TBS) or Pap grading for classification and reporting), acetate/iodide staining (VIA/VILI), colposcopy, histopathological examination, and pathological diagnosis. The study collected the quarterly reported data from 1 183 counties of 30 provinces in 2014 and 1 130 counties of 30 provinces in 2013. Chi-square test was used to test the difference of positive detection rate, as well as precancerous cervical lesions, and cervical cancer detection rates among difference preliminary screening methods in 2012 and 2013. Results In 2012 and 2013, the number of cervical cancer screening was 10 621 482 and 10 321 835. The percentage of using ThinPrep cytological test as the screening method was 77.17%(n=8 196 627) and 77.07%(n=7 954 949) in 2012 and 2013, respectively. Among these ThinPrep cytological tests in these two years, 65.49%(n=5 368 194) and 71.67% (n=5 701 033) used TBS report system. The abnormality rate of colposcopy increased from 27.29% (170 063/623 161) to 31.15% (203 397/652 935) (χ2=2 295.94, P<0.001). The abnormality rate of histopathology test increased from 19.54% (37 992/194 394) to 35.43% (59 004/166 518) (χ2=11 523.58,P<0.001). All together, 27 341 cervical cancer or precancerous lesions have been detected in these two years. The detection rate of invasive cervical cancer increased from 18.02/100 000 in 2012 to 19.71/100 000 (χ2=7.90, P=0.005) in 2013 and that of precancerous lesions rose from 106.85/100 000 to 119.26/100 000 (χ2=70.82, P<0.001). The early detection rate was 89.60% (11 883/13 263), and 89.57%(12 609/14 078), respectively in 2012 and 2013. In these two years, the rank of the detection rate of each cervical lesion were CIN1, CIN2, CIN3, invasive carcinoma, adenocarcinoma in situ, and microinvasive carcinoma, from the highest rate to the lowest rate. Conclusion The program has achieved certain screening effect and the screening method has been improved. However, the quality of colposcope and histopathology should be enhanced.

Objective To analyze the reported data of national rural cervical cancer screening project from 2012 to 2013 and to evaluate the project implementation condition. Methods Data of the national breast carcinoma and cervical cancer (two-cancer) screening project for rural women were collected from the online report system of key women and children's public health service programs.The screening items included: preliminary screening of cervical lesions (cervical cytology, using Traian Bethesda System (TBS) or Pap grading for classification and reporting), acetate/iodide staining (VIA/VILI), colposcopy, histopathological examination, and pathological diagnosis. The study collected the quarterly reported data from 1 183 counties of 30 provinces in 2014 and 1 130 counties of 30 provinces in 2013. Chi-square test was used to test the difference of positive detection rate, as well as precancerous cervical lesions, and cervical cancer detection rates among difference preliminary screening methods in 2012 and 2013. Results In 2012 and 2013, the number of cervical cancer screening was 10 621 482 and 10 321 835. The percentage of using ThinPrep cytological test as the screening method was 77.17%(n=8 196 627) and 77.07%(n=7 954 949) in 2012 and 2013, respectively. Among these ThinPrep cytological tests in these two years, 65.49%(n=5 368 194) and 71.67% (n=5 701 033) used TBS report system. The abnormality rate of colposcopy increased from 27.29% (170 063/623 161) to 31.15% (203 397/652 935) (χ2=2 295.94, P<0.001). The abnormality rate of histopathology test increased from 19.54% (37 992/194 394) to 35.43% (59 004/166 518) (χ2=11 523.58,P<0.001). All together, 27 341 cervical cancer or precancerous lesions have been detected in these two years. The detection rate of invasive cervical cancer increased from 18.02/100 000 in 2012 to 19.71/100 000 (χ2=7.90, P=0.005) in 2013 and that of precancerous lesions rose from 106.85/100 000 to 119.26/100 000 (χ2=70.82, P<0.001). The early detection rate was 89.60% (11 883/13 263), and 89.57%(12 609/14 078), respectively in 2012 and 2013. In these two years, the rank of the detection rate of each cervical lesion were CIN1, CIN2, CIN3, invasive carcinoma, adenocarcinoma in situ, and microinvasive carcinoma, from the highest rate to the lowest rate. Conclusion The program has achieved certain screening effect and the screening method has been improved. However, the quality of colposcope and histopathology should be enhanced.