ABSTRACT
Objective To investigate the role and significance of opportunistic screening in cervical cancer screening for elderly women aged≥65 years old. Methods The screening data of 1 304 elderly women (≥65 years old) who underwent opportunistic screening for cervical cancer at the Cancer Hospital, Chinese Academy of Medical Sciences, between January 1, 2010, and December 31 st, 2018, were analyzed retrospectively. Women who underwent cervical cytology tests and human papillomavirus (HPV) testing were divided into two groups according to age as following 65-69 and ≥70 years old. Women with abnormal cytology or who were hrHPV-positive were followed up. The cervical cytological abnormalities and high-risk HPV infection rates in women aged≥65 years in opportunistic screening were analyzed. Results Of all cases, 175 had abnormal cytology or were hrHPV-positive. Among the 1 304 women, 69 were TCT-positive, with a positivity rate of 5.3%, including 17 cases (24.6%) of high-degree squamous intraepithelial neoplasia and 3 cases (4.4%) of squamous cell carcinoma. The total abnormality rate of TCT in the 65-to 69-year age group (6.7%, 43 cases) was significantly higher than that in the≥70 age group (3.9%, 26 cases), and the difference was statistically significant between the two groups (P=0.024). The overall prevalence of hrHPV infection was 10.7% (139/1 304). HPV58 (31/174, 17.9%) was identified as the most common high-risk HPV type, followed by HPV16, HPV52, HPV33, and HPV31. Follow-up showed that 50.3% of the women had never been screened in the past 10 years, and no statistically significant difference in TCT abnormality and hrHPV infection positivity rate were found between those who had been screened (80 cases) and those who had not been screened at least once in 5 years (87 cases) (P>0.05). Conclusion Attention should be paid to the screening for cervical cancer in elderly women aged ≥65 years old. Opportunistic screening is a supplement to the population-based organized cervical cancer screening. The termination age of cervical cancer screening for elderly women may be appropriately extended.
ABSTRACT
Objective@#To analyze the screening results of cervical cancer in elderly women in Beijing and Guizhou. To compare the screening effectiveness of cervical cancer in elderly women in different areas.@*Methods@#A retrospective analysis was performed on the screening data of elderly women (≥50 years) who had examination at cervical lesion clinic in Peking University People′s Hospital and Affiliated Hospital of Guizhou Medical University from January 2013 to January 2014, with histopathology as the gold standard, to compare screening effectiveness of cervical cytology or HPV detection for elderly women in cervical cancer screening in the two regions.@*Results@#Among the patients with cervical intraepithelial neoplasia grade 2 and above (CIN2 + ) detected by colposcopy in Peking University People′s Hospital and Affiliated Hospital of Guizhou Medical University, 44.1% (82/186) and 57.0% (98/172) were women aged 50 and older. In Beijing group 39.0% (32/82) of CIN2 + patients had clinical symptoms, which in Guizhou group was 31.6% (31/98). In Beijing group and Guizhou group, 50.0% (19/38) and 73.2% (30/41) patients with cervical cancer had never been screened, respectively. In Beijing group and Guizhou group, 5.4% (4/74) and 19.2% (10/52) of the patients with CIN2 + had cervical cytology negative for intraepithelial lesion or malignancy (NILM), respectively (P=0.015). The cervical cytology showed atypical squamous cells of undetermined significance (ASC-US) in 10.2% (13/127) and 24.6% (14/57), respectively, with significant difference (P=0.01). The cervical cytology showed low-grade squamous intraepithelial lesions (LSIL) in 14.9% (11/74) and 37.5% (6/16) with no significant difference (P=0.08). Atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H) were 41.7% (5/12) and 71.4% (20/28) with no statistically significant difference (P=0.15). High-grade squamous intraepithelial lesions (HSIL) were 78.9% (15/19) and 86.4% (19/22) with no significant difference (P=0.83). In cases with HPV detection information, the sensitivity of CIN2+ diagnosis by high-risk HPV detection in Beijing group and Guizhou group was 95.2% (40/42) and 73.6% (39/53) that was statistically significant (P<0.05).@*Conclusions@#In both Beijing and Guizhou, the incidence of CIN2+ in elderly women is at a relatively high level. There were differences in the detection of CIN2+ by cervical cytology or HPV detection in Beijing and Guizhou.