Barriers to cervical cancer prevention and triage strategies: a study of knowledge, attitudes, and p16/Ki-67 dual-staining utility among high-risk women in Tuoli and Fuyun counties, Xinjiang
Objective
To investigate cervical cancer screening knowledge, attitudes, and practices among high-risk women in remote western China, and to identify socioeconomic and systemic barriers influencing screening participation. Additionally, to evaluate the comparative effectiveness of p16 staining versus p16/Ki-67 dual-staining immunocytochemistry in triaging women with cytological abnormalities or HPV-positive results, aiming to reduce unnecessary colposcopy referrals in resource-limited settings.
Methods
This cross-sectional study enrolled 260 women (aged 20–65 years) with cytological abnormalities or HPV-positive results from two remote counties in Xinjiang Province (January–December 2023). Participants completed structured questionnaires assessing cervical cancer knowledge, screening attitudes, and healthcare access. Cervical specimens collected via liquid-based cytology underwent parallel testing: conventional cytology, p16 staining, and p16/Ki-67 dual-staining, with all analyses performed by blinded pathologists.
Results
Among 260 high-risk women in Xinjiang, cervical cancer awareness (67.31%, 95% CI [61.50–72.90]) and screening rates (56.15%, 95% CI [50.23–62.17]) remained suboptimal. Multivariable analyses revealed significant disparities: college-educated women had 7.58-fold higher odds of awareness (95% CI [2.32–24.75]) compared to those with primary education, while public servants showed the strongest employment-based association (aOR = 11.23, 95% CI [2.64–47.83]). Mediation analysis demonstrated that health awareness fully mediated the effect of education (128.8% mediation) and nearly fully mediated the effect of employment (93.8%). Notably, 93.98% (95% CI [90.85–96.27]) expressed willingness to rescreen, and 82.95% (95% CI [78.33–86.84]) supported HPV vaccination. Biomarker analysis showed that p16/Ki-67 dual-staining positivity increased progressively with lesion severity (P < 0.001).
Conclusion
This study reveals suboptimal cervical cancer knowledge and screening rates among women in Xinjiang, with socioeconomic disparities—particularly in education and employment—primarily mediated through health awareness. The findings support integrated interventions, including physician-led education, digital health communication for media-dependent populations, simplified visual materials for less-educated women, and active linkage to national screening programs for unemployed populations. High rescreening willingness and parental acceptance of HPV vaccination indicate strong potential for intervention. p16 staining and p16/Ki-67 dual-staining show promise for triage in resource-limited settings. These findings highlight the need for tailored strategies to enhance cervical cancer prevention in western China, with further research needed to address current limitations.