Risk factors for gastric cancer: a large-scale, population-based case-control study / 中华医学杂志(英文版)

BACKGROUND@#Early detection of gastric cancer (GC) has been the topic of major efforts in China. This study aimed to explore the risk factors associated with GC and to provide evidence for the selection of a high-risk population of GC.@*METHODS@#Based on the cancer screening cohort of the National Cancer Screening Program in Urban China, GC patients diagnosed by endoscopy and pathological examinations constituted the case group, and controls were 1:3 matched by sex and age (±5 years) individually. The variables were selected by univariable analysis of factors such as body mass index (BMI), dietary habits, lifestyle, stomach disease history, and family history of GC; and multivariable logistic regression was used to analyze the influencing factors of GC and to calculate the odds ratio (OR) of related factors and its 95% confidence interval (CI).@*RESULTS@#A total of 215 GC cases and 645 matched healthy controls were included in the final analysis, with a median age of 61 years for the case and control groups. Overall analysis showed that high educational level (above primary school) (OR = 0.362, 95% CI = 0.219-0.599, P < 0.001), overweight/obesity (BMI ≥24 kg/m2; OR = 0.489, 95% CI = 0.329-0.726, P < 0.001), cigarette smoking (OR = 3.069, 95% CI = 1.700-5.540, P < 0.001), alcohol consumption (OR = 1.661, 95% CI = 1.028-2.683, P = 0.038), history of stomach disease (OR = 6.917, 95% CI = 4.594-10.416, P < 0.001), and family history of GC in first-degree relatives (OR = 4.291, 95% CI = 1.661-11.084, P = 0.003) were significantly correlated with the occurrence of GC. Subgroup analyses by age and gender indicated that GC risk was still increased in the presence of a history of stomach disease. A history of chronic gastritis, gastric ulcer, or gastric polyposis was positively associated with GC, with adjusted ORs of 4.155 (95% CI = 2.711-6.368), 1.839 (95% CI = 1.028-3.288), and 2.752 (95% CI = 1.197-6.326).@*CONCLUSIONS@#Subjects who smoke, drink, with history of stomach disease and family history of GC in first-degree relatives are the high-risk populations for GC. Therefore, attention should be paid to these subjects for GC screening.

The relationship between inflammatory factors and the risk of breast cancer in Kailuan cohort / 中华疾病控制杂志

Objective To investigate whether elevated baseline levels of high sensitivity C-Reactive Protein (hsCRP) and neutrophil (NE) are associated with an increased risk of breast cancer in Kailuan female cohort. Methods Females from Kailuan cohort (2006-2007) were included in this study. Information on check-up, hsCRP and NE were collected at baseline for all subjects. Multivariable Cox proportional hazards regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (95%CI) of association between baseline hsCRP and NE values and breast cancer risk. Results By December 31, 2015, a total of 18 866 participants were enrolled in this study. During the follow-up, 183 new cases of breast cancer were observed. All participants were divided into three groups according to the level of hsCRP (3 mg/L). The cumulative incidence of breast cancer were 829/105, 1 211/105 and 1 495/105 in these 3 groups, respectively ( 2=12.08， P=0.002). Compared with participants with lower hsCRP levels (3 mg/L) levels had significantly increased risk of breast cancer (HR=1.71,95%CI: 1.18-2.47, P=0.005), howerver, we didn’t find the statistically significant association between NE level (0.05). Conclusions Elevated levels of hsCRP at baseline might increase the risk of breast cancer in females.

Effectiveness and health economic analysis of strategies on cervical cancer screening and early diagnosis and treatment / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To 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.</p><p><b>METHODS</b>Markov 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.</p><p><b>RESULTS</b>All 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%.</p><p><b>CONCLUSIONS</b>careHPV 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.</p>

Prevalence of high-risk human papillomavirus and incidence of cervical intraepithelial neoplasia in female populations in Shenzhen, Guangdong Province / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the prevalence of high-risk human papillomavirus (HPV) and incidence of cervical intraepithelial neoplasia (CIN) in female populations in Shenzhen, Guangdong Province, China.</p><p><b>METHODS</b>Totally 1137 women aged 15-59 from Shahe Community, Nanshan District, Shenzhen were investigated for cervical cancer during an population-based epidemiological screening from November 2004 to December 2004. Visual inspection with acetic acid (VIA), colposcopy, liquid-based cytology test (LCT), and hybrid capture 2 (HC-) were performed to detect the high-risk HPV types in cervical secretions. Biopsy under colposcope was performed in women who were HPV-positive with LCT >or= atypical squamous cells of undetermined sign (ASCUS) or HPV-negative with LCT >or= low grade squamous intraepithelial lesion (LSIL), with the pathological results as the golden standards.</p><p><b>RESULTS</b>The detection rate of high-risk HPV-DNA was 14.0%. HPV detection rates in 15-24, 25-29, 30-34, 35-39, 40-44, 45-49, and 50-59 age groups were 15.5%, 17.7%, 12.6%, 8.8%, 10.2%, 15.3%, and 21.0%, respectively (P < 0.05). HPV detection rates in 25-29 years group and 50-59 years group were significantly higher than those in other groups (P < 0.05) and 35-39 group had the lowest detection rate. The curve of HPV infection rates in all groups was 'V' type. The overall incidence of CIN was 4.4%. The incidences of CIN , CIN , and CIN were 3.2%, 1.0%, and 0.3%, respectively, in which the incidence of CIN was significantly higher than those of CIN and . HPV detection rates increased with cervical lesion grades, which in >or=CIN groups and normal group were 100.0% and 8.3%, respectively. No cervical cancer was identified in this research. The sensitivities of VIA, colposcopy, LCT, and HC-II for high-risk HPV screening were 35.7%, 50.0%, 92.9%,and 100%, respectively, in detecting high-grade squamous intraepithelial lesion (HSIL), the specificities of these four methods were 96.0%, 87.2%, 88.4%, and 86.9%, respectively. Satisfactory negative predictive values were obtained for all methods.</p><p><b>CONCLUSIONS</b>HPV infection is the main risk factor for CIN. Cervical cancer among female populations in Shenzhen is still in early stages. Prevention of HPV infection and treatment of CIN are key for the prevention of cervical cancer.</p>

Feasibility of packaging screening for cervical cancer, breast cancer, and reproductive tract infection in a rural area in China / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the prevalence of cervical cancer, breast cancer, and reproductive tract infection (RTI) among women living in a county of China, identify these women's recognition about these three diseases and their attitude toward the screening, and evaluate the feasibility of the packaging screening program in rural areas in China.</p><p><b>METHODS</b>In this cross-sectional study, women aged 30-59 living in Xiangyuan County, Shanxi Province, were surveyed by questionnaires and screened with visual inspection of cervix, breast clinic examination, and combined clinical examination and laboratory tests for RTI.</p><p><b>RESULTS</b>Totally 630 women underwent interviews and packaging screening. The prevalences of cervical precancerous lesion, breast benign disease, and RTI were 0.2%, 14.0%, and 53.2%, respectively. No cancer case was found. The percentages of women knowing cervical cancer, breast cancer, and RTI as common diseases in women were 70.5%, 63.5%, and 52.9% after health education. Up to 92.5% of women preferred packaging screening to screening for single disease; however, they were not willing to pay the screening at current high cost.</p><p><b>CONCLUSIONS</b>The prevalences of breast benign disease and RTI are relatively high among women in rural areas in China. The women's recognition about these three diseases is moderately good. The packaging screening program is well accepted and feasible in rural areas.</p>

Study on the prevalence of human papillomavirus infection and distribution of types in Shenyang city / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the status of infection and type-specific distribution on human papillomavirus (HPV) in the urban areas of Shenyang city, China and to provide data for vaccine introduction.</p><p><b>METHODS</b>A list of 1000 women aged 15-59 years were obtained randomly from the local population, and a questionnairey was filled in. Samples of cervical cell were obtained from 702 women who had had sexual experience and were not pregnant during the study was carried on. HPV type was detected using a GP5+/6+ -based PCR, liquid-based cytology, VIA, VILI and electronic coloscopy were used for screening on cervical cancer.</p><p><b>RESULTS</b>The prevalence of any HPV type was 17.0% among the 702 women who had been enrolled in this study, 64.1% in women with abnormal cytology, 11.1% in women with normal cytology and the difference was significant. The prevalence of high-risk HPV type was 11.9% and the low-risk type was 6.5%. The prevalence of either high-risk or low-risk HPV type was significantly higher in women with abnormal cytology than those with normal cytology. There were a total number of 32 HPV types identified and the most common HPV types were 16 (3.4%), 52 (2.4%) and 58 (1.9%). The prevalence rates of either high-risk or low-risk HPV type were not statistically different among different age-groups with P>0.05. HPV types with high risk were predominantly distributed in the groups below 45 years old and the difference was significant with P < 0.05. There was no significant difference between high-risk and low-risk types above 45 years old.</p><p><b>CONCLUSION</b>The prevalence of HPV in women with abnormal cytology was statistically higher than those with normal cytology. The most common HPV types in this population were 16, 52 and 58, and the validity of present vaccines was not good enough for cervical cancer prevention in this local area.</p>

Distribution of human papillomavirus types in Shenzhen women / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the status of genital infection as well as distribution of types of human papillomavirus (HPV) in women in Shenzhen and provide population data for the future vaccine intervention on cervical cancer.</p><p><b>METHODS</b>Women with age between 15 and 59 years were selected in cluster stratified sampling from Huaqiaocheng community, Nanshan district, Shenzhen and received a population-based cervical cancer screening. After consent, every woman was interviewed by using questionnaire and tested by liquid-based cytology and HPV DNA (hybrid capture 2 and gene chips typing) separately.</p><p><b>RESULTS</b>Totally 1 137 women were screened. The rate of high risk HPV of hybrid capture 2 test (14. 0% ) was higher than gene chips typing test (9. 8%) (chi(2) = 27. 198, P < 0. 001) ; the consistency of the two tests was acceptable ( kappa = 0. 498, P < 0. 001). The rates of low risk HPV types and other types of gene chips typing test in this population were 1. 9% and 0. 2% respectively. The percentages of HPV 16, 18 and 58 in HPV positive women were 29. 7% , 18. 9% and 18. 9%. The rates of different age group of low risk HPV were 1. 4% (17-34), 1. 7% (35-44) and 3. 2% (45-59) , respectively.</p><p><b>CONCLUSIONS</b>HPV 16, 18, and 58 are the most popular types in the study population. The differences of infection rates of high risk HPV are due primarily to the variation of HPV16 distribution among age-specific population. The chances of being affected by low risk HPV will increase with age.</p>