Linhong Wang

A nationally quasi-experimental study to assess the impact of partial organized breast and cervical cancer screening programme on participation and inequalities

AbstractBackgroundOrganized breast and cervical cancer screening programme could only provide services at no cost for a fraction of socioeconomic-deprived women in China and other low-resource countries, however, little evidence exists for whether such a programme effectively affect the participation and inequalities at the population level.MethodsWe used individual-level data from a nationally cross-sectional survey in 2014–2015 for breast and cervical cancer screening participation. Data for intervention and comparison grouping were from 2009 to 2014 national breast and cervical cancer screening programme, and counties covered by the programme were divided into intervention group. We assessed the impact of the intervention on the participation rates and the magnitude of inequalities with two approaches: multivariable multilevel logistic regressions adjusting for individual- and region-level covariates; and a difference analysis combined with propensity score matching that estimated the average intervention effect.ResultsOf 69,875 included women aged 35–64 years, 21,620 were classified into the intervention group and 43,669 into the comparison group for breast cancer screening; and 31,794 into the intervention group, and 33,682 into the comparison group for cervical cancer screening. Participation rate was higher in intervention group than comparison group for breast cancer screening (25.3, 95% confidential interval [CI], 22.8–27.7%, vs 19.1, 17.4–20.7%), and cervical cancer screening (25.7, 23.8–27.7%, vs 21.5, 19.6–23.5%), respectively. Intervention significantly increased the likelihood of participation for both breast cancer and cervical cancer screening in overall women, rural women and urban women, whereas the effect was significantly higher in rural women than urban women. The average intervention effect on the participation rate was an increase of 7.5% (6.7–8.2%) for breast cancer screening, and 6.8% (6.1–7.5%) for cervical cancer screening, respectively. The inequalities were significantly decreased by 37–41% (P < 0.001) between rural and urban, however, were slightly decreased or even increased in terms of age, education status, and household income.ConclusionsOrganized breast and cervical cancer screening programme targeting for a fraction of women could increase the participation rates at population level, however, it could not significantly affect socioeconomic-introduced inequalities. Further studies are need to conduct time-series analyses and strengthen the causal correlation.

HPV‐negative high‐grade cervical precancerous lesions or invasive cancer in China: A post hoc analysis of a multicentric clinical study

AbstractObjectiveTo evaluate HPV‐negative cervical high‐grade precancerous lesions or cancer in China.MethodsHistologically confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) were searched in a multicentric clinical study. All patients underwent cobas HPV testing, liquid‐based cytology, DNA ploidy analysis, and colposcopy‐guided biopsy. According to clinical practice, patients underwent p16ink4a staining and cone biopsy. Comparisons were made between HPV‐negative and ‐positive patients for clinical characteristics.ResultsThe study found 61 cases of cobas HPV‐negative CIN2+ among 797 cases of histologically confirmed CIN2+, including 38 CIN2, 20 CIN3, and 3 invasive cancers. The prevalence of HPV‐negative CIN2+ and CIN3+ was 7.7% (95% confidence interval [CI] 5.8–9.5) and 5.7% (95% CI 3.5–8.0), respectively. Among 24 cases with p16 staining, 20 showed p16 positivity. The proportions of normal or minor abnormalities in terms of colposcopy, cytology, and DNA ploidy were higher in HPV‐negative cases than in HPV‐positive cases. When adding cytology to the screening of symptomatic or previously HPV‐positive women, the prevalence of HPV‐negative CIN2+ or CIN3 would decrease by approximately 50%.ConclusionLess than one‐tenth of CIN2+ are missed by HPV‐only screening, and they have smaller lesions than HPV‐positive cases. Colposcopy should be considered for symptomatic or previously HPV‐positive women with HPV‐negative results.