Association between high-risk human papillomavirus DNA load and cervical intraepithelial lesion / 中华流行病学杂志

<p><b>OBJECTIVE</b>To determine the association between viral load of high risk type human papillomavirus (HR-HPV) and stage of cervical intraepithelial neoplasia (CIN) lesion.</p><p><b>METHODS</b>Cervical exfoliated cells were collected from 1997 women aged 35-45 in a cross-sectional screening study. HPV DNA was detected by hybrid capture 2 (HC2) system, and viral load was measured by the ratios of relative light units compared to standard positive control (RLU/PC). Log10RLU/PC were categorized into four groups: negative (< 0), low viral load (0 - 1.12), medium viral load (1.13 - 2.23), and high viral load (2.24 - 3.37). Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2-3, and squamous cervical cancer (SCC). Association between HR-HPV and CINs were evaluated by unconditional multinomial logistic regression.</p><p><b>RESULTS</b>100% (12/12) SCC, 97.3% (72/74) of CIN 2-3, 58.3% (74/127) of CIN 1, and 11.5% (205/1784) of normal women were positive for HPV DNA. The median log10RLUs for the positive women with SCC, CIN 2-3, CIN 1 and in normal women were 2.60, 2.32, 2.18 and 1.18 respectively. The odds ratio (OR) between low viral load of HPV DNA and CIN 1 was 3.8 (1.9 - 7.3) while between high viral load and CIN 2-3 was OR=865.9 (200.1 - 3738.0) which showed that higher viral load could increase the risk of cervical lesions (P <0.001).</p><p><b>CONCLUSION</b>Both cervical cancer and CINs were highly influenced by HR-HPV viral load.</p>

Population-based study of human papillomavirus infection in high-risk area for cervical cancer in Shanxi Province, China / 中国医学科学院学报

<p><b>OBJECTIVES</b>To investigate the prevalence of oncogenic type of human papillomavirus (HPV) infection and identify the high risk population for conducting immuno/chemoprevention of cervical cancer.</p><p><b>METHODS</b>All married women aged 30 to 50 with no history of hysterectomy, pelvic radiation and non-pregnant from certain villages of Xiangyuan and Yangcheng County were invited. This study was conducted through two phases. In phase one, subjects sampled the vaginal secretions using the collectors after signing the informed consent. And physicians sampled exfoliated cells from cervix in the phase two. All the specimens were tested with the Hybrid Capture 2 test. The data was managed and analyzed by VFP and SPSS software.</p><p><b>RESULTS</b>There were 9,683 women participated in this study. Local women welcomed this study and population compliance rate was 75.4%. In tested population, we found 2,666 subjects of HPV DNA positive and HPV prevalence was 27.5%. The rates of different age group were 24.5% (30-34 yrs), 27.4% (35-39 yrs), 28.2% (40-44 yrs), 27.4% (45-50 yrs) respectively and had no significant differences (P = 0.604). The rates were slightly increased with the higher education level and had no differences (P = 0.106). The rate in mountain areas was higher than that in half-mountain areas (P = 0.001).</p><p><b>CONCLUSIONS</b>The prevalence of HPV infection is indeed high in this region. Local women and health professionals welcome the activities of cervical cancer screening and prevention. It is an emergent task to improve their sanitary condition and prevent them from cervical cancer in these women. A women health cohort is established successfully among high HPV exposed women in rural China. The extensive biologic specimen repository has been successfully established to simultaneously study the etiology, early detection, and immuno/chemoprevention of cervical cancer.</p>

A methodology study on assessment of cancer screening test / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the effect of gold standard, blind comparison and different cut-points choosing on screening techniques assessment, and to promote the application of evidence-based medicine theory in screening study.</p><p><b>METHODS</b>A screening study for cervical cancer in rural China in 1999, where 1997 women had been tested for pathology as gold standard and simulating situations without gold standard, blind comparison and under different cut-points. Indices such as detectable rate, sensitivity and specificity were calculated for each technique. Receiver operating characteristics (ROC) curves were drawn and areas under ROC curves between screening techniques were tested.</p><p><b>RESULTS</b>Without gold standard, diagnostic techniques could not be evaluated correctly, and without the blind comparison, the sensitivity and specificity of the tests would be subjectively increased. Furthermore, use of different cut-points led to different sensitivities and specificities of test.</p><p><b>CONCLUSIONS</b>Gold standard, blind comparison and perfect cut-points can improve the quality of screening test and drawing ROC curves is an effective way to confirm cut-points and evaluate diagnostic techniques. It is necessary to enforce the application of evidence-based medicine theory in scientific research.</p>