OBJECTIVETo observe the correlation between human papillomavirus (HPV) infection and cervical lesion among women living in community of Beijing.

METHODSA total of 795 women at age 20-54, living in Zhanlanlu District of Beijing were screened for cervical lesion. Samples of cervical cytology (LCT) and HPV test (hc2) were collected. Colposcopy and biopsy were conducted in women with positive LCT.

RESULTSIn those 795 women, the infection rate of HPV was 14.1% (112/795). In 40 women who were LCT positive 1 early invasive cervical cancer, 4 cervical intra-epithelial neoplasia (CIN3), 3 CIN2 and 7 CIN1 were noticed. In 750 women with negative LCT, 5 CIN1 and 1 low-grade CGIN were diagnosed. In those women who were Cyto(+) and HPV(+), 15 cases (55.6%, 15/27) were diagnosed with > or = CIN1 (including 7 CIN1, 3 CIN2, 4 CIN3 and 1 early invasive cancer).

CONCLUSIONThe risk of cervical lesion significantly increased in women showing positive in cytology and HPV test.

Adult ; Biopsy ; Cervical Intraepithelial Neoplasia ; diagnosis ; epidemiology ; virology ; Cervix Uteri ; virology ; China ; epidemiology ; Colposcopy ; Female ; Humans ; Middle Aged ; Papillomavirus Infections ; epidemiology ; Risk Factors ; Uterine Cervical Diseases ; epidemiology ; Uterine Cervical Neoplasms ; diagnosis ; epidemiology ; virology ; Vaginal Smears ; Young Adult

Cervical Intraepithelial Neoplasia ; diagnosis ; epidemiology ; prevention & control ; virology ; China ; epidemiology ; Female ; Humans ; Mass Screening ; Nucleic Acid Hybridization ; methods ; Papillomaviridae ; isolation & purification ; Papillomavirus Infections ; diagnosis ; prevention & control ; Papillomavirus Vaccines ; Uterine Cervical Neoplasms ; diagnosis ; epidemiology ; prevention & control ; virology ; Vaginal Smears

OBJECTIVETo evaluate the application value and feasibility of various cervical screening methods and to explore a rapid and efficient cervical cancer screening program for the women in the rural areas of China.

METHODSWe sequentially conducted human papillomavirus (HPV) DNA test by hybrid capture-2 (hc2) with cervical cells, liquid-based thinprep cytology test (TCT), visual inspection with acetic acid (VIA), visual inspection with iodine (VILI), colposcopy respectively for the 2499 married women between 30 and 49 years from Xiushui county of Jiangxi province. All the detection methods were performed independently under double-blind design. Women who were diagnosed positive for having any VIA,VILI and colposcopy inspection or for those women who were diagnosed negative for VIA, VILI and colposcopy but with positive result of HPV or TCT test underwent cervical biopsy directly and endocervical curettage (ECC)when necessary. We performed cervical biopsy endocervical curettage within two weeks to observe the sensitive (SE), specificity (SP), negative predict value (NPV) and positive predict value (PPV) of these detection methods when used alone or combined each other, including HPV test, TCT inspection, VIA, VILI, and colposcopy, the pathological diagnosises of cervical tissue were confirmed by IARC (International Agency for Research on Cancer) while the cytological findings were underegone through the updated program of TBS (The Bethesda System) in 2001.

RESULTSA total of 2499 women underwent the screening and found 443 women who were diagnosed as HPV positive, 337 women with abnormal cervical cytology and 27 women with ASC-H, 157 cases with ASCUS; 103 cases with HSIL, 49 cases with LSIL and 1 cervical cancer. According to the pathological findings. There were 181 women diagnosed as cervical intraepithelial neoplasia (CIN) or cervical cancer, including 81 cases with CIN1 37 cases with CIN2,60 case cervical cancer. The sensitivity rates of HPV, TCT, HPV+ TCT, VIA, VILI, VIA+VILI and colposcopy were 96.67%, 89.47%, 97.98%, 56.57%, 36.36%, 63.64% and 39.39%, and the specificity rates were 85.00%, 96.91%, 86.97%, 94.60%, 96.23%, 92.97% and 98.14% respectively.

CONCLUSIONHPV + TCT seemed to be more sensitive than other screening methods in the cervical cancer screening program.

Adult ; China ; epidemiology ; Early Detection of Cancer ; methods ; Female ; Humans ; Mass Screening ; methods ; Middle Aged ; Papillomavirus Infections ; diagnosis ; epidemiology ; Predictive Value of Tests ; Rural Population ; Sensitivity and Specificity ; Uterine Cervical Neoplasms ; diagnosis ; epidemiology ; virology

OBJECTIVE: This study was performed to evaluate the clinical performance of APTIMA human papillomavirus (AHPV) assay and Hybrid Capture 2 (HC2) assay in screening for cervical disease, especially in women with atypical squamous cell of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL). METHODS: A total of 411 women diagnosed with ASC-US or LSIL were referred and further triaged by HC2 test. Prior to colposcopy, liquid-based cytology specimens were collected for the AHPV assay. Sensitivity and specificity were established based on the histological findings of cervical intraepithelial neoplasia (CIN). RESULTS: In all 411 subjects, the positive detection rate of AHPV assay was 70.8% (95% confidence interval [CI], 66.4 to 75.2), which was significantly lower than the positive detection rate of 94.9% obtained using HC2 test (95% CI, 92.3 to 96.8). Only one CIN 3-positive case was detected among the 120 AHPV-negative women, which was then confirmed by Pap smear test to be LSIL. The sensitivities of AHPV and HC2 for CIN 3 were similar (94.1% and 100%, respectively). However, AHPV showed a significantly higher specificity than HC2 test (30.2% and 5.3%, respectively; p<0.001). CONCLUSION: AHPV assay is effective in identifying CIN 3-positive cases because of its high specificity and lower false-negative rate. The use of AHPV for the triage of ASC-US and LSIL might help to reduce the referral rate of colposcopy during cervical cancer screening.
Adult ; Aged ; Cervical Intraepithelial Neoplasia/*diagnosis/epidemiology/virology ; China/epidemiology ; Colposcopy/methods ; Early Detection of Cancer/methods ; False Negative Reactions ; Female ; Human Papillomavirus DNA Tests/*methods ; Humans ; Middle Aged ; Papillomavirus Infections/complications/*diagnosis/epidemiology ; Prevalence ; Sensitivity and Specificity ; Triage ; Uterine Cervical Neoplasms/*diagnosis/epidemiology/virology ; Young Adult

OBJECTIVETo explore the appropriate strategies which are suitable for the areas with diverse health and economic resource settings in China by estimating the life outcomes and cost-effectiveness of several cervical cancer screening strategies.

METHODSMarkov model was used to calculate the long-term effectiveness, utility, benefit and cost among screened and unscreened cohorts in rural and urban areas, and then analyses of cost-effectiveness, cost-utility and cost-benefit were performed. The assessed screening strategies were acetic acid of visual inspection combined with Lugol's iodine staining (VIA/VILI), conventional Pap smear and simple HPV DNA testing (careHPV) in rural areas, and conventional Pap smear, simple HPV DNA testing (careHPV), HPV DNA testing (HC2) and liquid-based cytology (LBC) alone or combined with HPV DNA testing (LBC+HC2) in urban areas. We estimated the life outcomes and cost-effectiveness of the above screening strategies at one-year, 3-year and 5-year intervals.

RESULTSAll of the screening strategies were effective to decrease cervical cancer mortality and to increase life years, with a trend of shorter screening interval having better effectiveness. However, no matter in urban or rural areas, compared with careHPV testing at 5-year interval, the costs of other screening strategies were 1.28 - 13.86 folds, 1.31 - 14.14 folds, and 1.27 - 12.80 folds higher to avoid one death, to save a year of life, and a QALY, and the benefit per cost of other screening strategies was 9.9%-90.2%.

CONCLUSIONScareHPV testing at 5-year interval has the best cost-effectiveness performance and the highest benefit-cost ratio with the moderate life outcomes. It is the optimal cervical cancer screening strategy to be generalized in our country. careHPV testing at 3 years interval can be considered in more developed areas to achieve better effectiveness.

Acetic Acid ; Adult ; Cervical Intraepithelial Neoplasia ; diagnosis ; economics ; epidemiology ; virology ; China ; epidemiology ; Cost-Benefit Analysis ; Cytological Techniques ; DNA, Viral ; analysis ; Early Detection of Cancer ; economics ; methods ; Female ; Human Papillomavirus DNA Tests ; Humans ; Iodides ; Markov Chains ; Mass Screening ; economics ; methods ; Middle Aged ; Models, Biological ; Models, Statistical ; Papanicolaou Test ; Quality-Adjusted Life Years ; Rural Population ; Urban Population ; Uterine Cervical Neoplasms ; diagnosis ; economics ; epidemiology ; virology ; Vaginal Smears

BACKGROUND: Human papillomavirus (HPV) prophylactic vaccines, bivalent types for HPV-16/18 with 70% prophylactic expectation, have been developed based on the genotypes found prevalent in the western countries, but little is known for those in Korea. Using a DNA chip test, we evaluated the clinical efficacy of HPV genotype based on cervical abnormalities. METHODS: As the initial diagnostic tests, HPV DNA chip tests and Papanicolaou smear (PAP) were used for 1,211 subjects. Cervical colposcopy directed biopsies were performed for 626 among the 1,211 subjects within one month. RESULTS: The most frequently found genotypes in all HPV-positive specimens (n=445) were HPV-16 (22.0%), 58 (13.9%), 52 (11.0%), 51 (9.0%), 56 (8.5%), and 18 (7.2%). HPV prevalence was significantly higher in specimens where PAP and biopsy results were closer to malignancy. The HPV genotype distribution of the histologically confirmed cervical high-grade squamous intraepithelial lesions (HSIL) or carcinoma cases showed HPV-16, 58, 52, 18, and 33, in descending order. The HPV DNA chip sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the detection of cervical HSIL or carcinoma were 76.9%, 70.1%, 72.1%, and 75.8%, respectively, Of these, the sensitivity and NPV were higher than those of PAP. PPV and NPV of HPV-16 were 90.5% and 60.7%, respectively, being the highest among the genotypes. CONCLUSIONS: We confirmed that HPV-16 genotype was also very important for the diagnosis of HSIL and cervical carcinoma in Korea. However, contrary to the findings in the western countries, the prevalence of HPV-58 was higher than that of HPV-18. Moreover, as the other HPV genotype reports were rare in Korea, further studies are required with the HPV DNA chip test before the nationwide adoption of the vaccines.
Adolescent ; Adult ; Aged ; Colposcopy ; DNA, Viral/analysis/isolation & purification ; Female ; Genotype ; Humans ; Middle Aged ; *Oligonucleotide Array Sequence Analysis ; Papillomaviridae/classification/*genetics/isolation & purification ; Papillomavirus Infections/*diagnosis/epidemiology/virology ; Papillomavirus Vaccines ; Polymerase Chain Reaction ; Reproducibility of Results ; Sensitivity and Specificity ; Uterine Cervical Neoplasms/*diagnosis/prevention & control/virology ; Vaginal Smears/methods ; Young Adult

OBJECTIVETo study the type-specific prevalence of human papillomavirus (HPV) infection among women in China and to provide evidence for primary prevention and screening of cervical cancer programs.

METHODSFrom May, 2004 to April, 2007, a population-based multicenter cross-sectional study was conducted by the Cancer Hospital, Chinese Academy of Medical Sciences. Women aged 17-59 years from 4 urban areas and 4 rural areas, were screened, under both liquid based cytological and HPV tests for cervical cancer. Specimens of cervical cell were used for genotyping with Linear Array or enzyme-linked immunesorbent assay. Women showed positive in primary screening were referred to exams for further colposcopy and/or histo-pathological detections.

RESULTSA total of 6723 women were included in the data analysis. The overall prevalence of HPV infection was 15.5%. Two age-specific peaks of prevalence of HPV infection were detected among the different age groups. The first peak occurred in 17-24 year-old women in both rural areas and urban areas, while the second one occurred in 40-44 year-old women in urban areas and in 45-49 year-old women in rural areas. The prevalence of HPV infection increased with the severity of diagnosed cervical intraepithelial lesions by cytological or histo-pathological test (χ(2)=62.857, 22.113, P<0.001). HPV16 (3.2%) was seen the most common high risk HPV type, followed by HPV58 (1.8%) , HPV52 (1.5%) , HPV18 (1.0%) and HPV33 (1.0%) respectively. Other common types would include HPV66 (0.64%) , HPV42 (0.58%) and HPV53 (0.46%). The prevalence of HPV16 infection in rural women was significantly higher than that in urban women (χ(2)=4.696, P< 0.05).

CONCLUSIONPrevalence of HPV infection in Chinese women seemed to be high and with two age-specific peaks. HPV16 appeared the most commonly seen type in women with cervical lesions. HPV58 and 18 were the predominant types. Type-specific distribution of HPV infection should be taken into consideration in the development of comprehensive cervical cancer prevention strategies in China.

Adolescent ; Adult ; Alphapapillomavirus ; isolation & purification ; China ; epidemiology ; Cross-Sectional Studies ; Early Detection of Cancer ; Female ; Genotype ; Human papillomavirus 16 ; isolation & purification ; Humans ; Middle Aged ; Papillomaviridae ; isolation & purification ; Papillomavirus Infections ; epidemiology ; virology ; Prevalence ; Primary Prevention ; Rural Health ; statistics & numerical data ; Urban Health ; statistics & numerical data ; Uterine Cervical Neoplasms ; diagnosis ; Young Adult