CLINICAL RESEARCH e-ISSN 1643-3750 © Med Sci Monit, 2016; 22: 1858-1865 DOI: 10.12659/MSM.894663

Epidemiological Investigation and Risk Factors for Cervical Lesions: Cervical Cancer Screening Among Women in Rural Areas of Henan Province China

Received: 2015.05.14 Accepted: 2015.06.15 Published: 2016.06.01

Authors’ Contribution: Study Design  A Data Collection  B Analysis  C Statistical Data Interpretation  D Manuscript Preparation  E Literature Search  F Funds Collection  G

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Qingwei Zhang Wenyan Xie Feng Wang Rong Hong Li Lina Cui Huifen Wang Xiuhong Fu Jiayu Song

1 Department of Obstetrics and Gynecology, Luohe Medical College First Affiliated Hospital, Luohe, Henan, P.R. China 2 Department of Pharmacy, Luohe Medical College First Affiliated Hospital, Luohe, Henan, P.R. China

Jiayu Song, e-mail: [email protected] This work was supported by Luohe city government support

This cross-sectional study aimed to investigate the prevalence of cervical lesions and evaluate risk factors for cervical intraepithelial neoplasia (CIN) among women taking part in cervical cancer screening in rural areas of Henan province, China. Cervical cancer screening using the ThinPrep cytologic test (TCT) and gynecologic exam was conducted on 1315 women age 20–68 years in rural areas of Henan province, China. Colposcopy and biopsies were carried out for histopathologic diagnosis when indicated. Univariate and multivariate logistic regressions were performed to evaluate risk factors associated with cervical lesions. Among 1315 women screened, CIN prevalence detected by histopathology was 1.22% (0.38% of CIN 1, 0.76% of CIN 2, and 0.08% of CIN 3). Cervical cancer prevalence was 2.66%. Multivariate analysis confirmed risk factors for cervical lesions included older age (the 21–40 age group vs. the 41–66 age group, OR=0.13, 95% CI: 0.03~0.57), postmenopause (OR=0.11, 95% CI: 0.03~0.45), cervical inflammation (OR=0.06, 95% CI: 0.01~0.31), and smoking (OR=6.78, 95% CI: 1.20~38.23). Older age (41–66 years), presence of HPV infection, postmenopause, cervical inflammation, and smoking are strong risk factors for cervical lesions among women in rural areas of Henan province, China. Particular efforts should be made to provide cervical cancer screening for these women. Cervical Intraepithelial Neoplasia • Risk Factors • Uterine Cervical Neoplasms

Abbreviations: CCA – cervical cancer; CIN – cervical intraepithelial neoplasia; HPV – human papillomavirus; TCT – ThinPrep cytology test Full-text PDF:

http://www.medscimonit.com/abstract/index/idArt/894663

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Zhang Q. et al.: Epidemiological investigation and risk factors for cervical lesions… © Med Sci Monit, 2016; 22: 1858-1865

CLINICAL RESEARCH

Background

Material and Methods

Cervical cancer (CCA), generally presenting malignancies in the uterus, cervix and vagina, is the second most common cancer among women, second only to breast cancer [1,2]. About 135 000 new cases occur each year in China, accounting for a third of the global cases; 73–93% of the female reproductive system tumor incidence, which is 6 times higher than in developed countries, and the cases tend to be younger [3]. Over the past 20 years, incidence and mortality of cervical cancer have been rising in China, with the rise of rural areas obviously higher than in cities.

Subjects and study design

Compared with other malignancies, CCA has characteristics with clearer pathogenic factors and longer reversible period of precancerous lesions, and often begins with cervical intraepithelial neoplasia (CIN) accompanied by progressive CIN1, 2, and 3. It was reported that at least 25% of women with CIN 2 and 3 progress to carcinoma in situ or invasive cancer if lesions are untreated [4]. Previous studies suggested that high-risk human papillomavirus (HR-HPV) infection is a main cause of CIN and invasive cervical cancer [5]. However, only a minority of HPV infections progress to CIN or CCA. Other correlative factors, such as oral contraceptive use and pregnancy frequency, affect HPV persistence and development from CIN to invasive CCA [6–8]. Systematic and effective screening, together with early diagnosis and treatment, can save 99% of the patients with CCA [9]; it is significant to reverse cervical precancerous lesions and block development of CCA by early screening and effective prevention. Due to active CCA prevention and screening in China, the mortality rate of CCA decreased in the 1990s, but had an increasing trend in recent years. The CCA screening work throughout China has not been evenly distributed and various regions have different trends. There has been no systemic and comprehensive research on risk factors for cervical lesions (including CIN and CCA) among women living in the rural areas of Luohe city, Henan province, central China, which has a high incidence of CCA. In this study, 1315 women were recruited for CCA screening. All women were offered gynecological examinations, HPV test, and ThinPrep cytology test (TCT) to estimate prevalence of cervical lesions and evaluate risk factors for cervical lesions, which provides evidence to nationwide screening strategies of the cervical cancer program.

This work is licensed under Creative Common AttributionNonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)

In rural areas of Henan province, China, 1315 women aged between 21 to 68 years old (mean years=41.84±7.80) attended cervical cancer screening. Inclusion criteria were: (1) current or past sexual activity; (2) not pregnant at the time of enrollment; (3) never been screened or treated for cervical cancer; (4) had not undergone a total uterus or cervix resection. All of the recruited subjects were familiar with the purpose and procedures of the study and signed informed consent forms before the study. Exclusion criteria were: difficulties in obtaining information; unanalyzable samples; pregnant women; history of uterectomy; and refusal to participate. The present study was conducted in accordance with the Declaration of Helsinki. All study protocols were approved by the Ethics Committee of the First Affiliated Hospital of Luohe Medical College. All the subjects completed the structured case report form (CRF) questionnaires for cervical cancer screening, including socio-demographic information, reproductive history, sexual behavior, birth control measures, medical history, gynecologic examination history, TCT and histologic test results, and demographic data of husbands. Socio-demographic information collected from each woman included age, education level, occupation, marital status, economic conditions, and living situation. Information was also recorded on reproductive history and sexual characteristics, including menarche age, length of menstrual cycle, menstrual capacity, menopausal age, number of pregnancies, number of abortions, delivery times, birth control measures, sanitary conditions of sexual life, and cervical inflammation. Medical history included any history of gynecological tumors, such as uterine sarcoma, fallopian tube tumors, ovary benign tumors or cancer, and vulvar carcinoma. Measurements TCT and histopathologic diagnosis Exfoliated cervical cells were collected from the ectocervix and endocervix with a plastic Ayres’s spatula and cytobrush. The collected cells were analyzed by TCT. Cytological findings were diagnosed according to the Bethesda classification system [10] and were classified as follows: a) negative; b) atypical squamous cells of undetermined significance (ASCUS); c) low-grade squamous intra epithelial lesion (LSIL); d) atypical squamous cells that cannot exclude HSIL (ASC-H); e) highgrade squamous intraepithelial lesion (HSIL). If TCT results were abnormal, participates were referred for colposcopic exams. A histologic test by biopsy was performed to determine

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Zhang Q. et al.: Epidemiological investigation and risk factors for cervical lesions… © Med Sci Monit, 2016; 22: 1858-1865

CLINICAL RESEARCH

CIN grade. CIN grades were categorized as CIN1, CIN2, and CIN3 according to Richard’s classification [11], in which CIN2 and CIN3 are defined as HSIL. HPV detection HPV DNA testing was conducted using polymerase chain reaction (PCR) and HPV types were detected by a commercial HPV genotyping kit (Yaneng Bioscience (Shenzhen) Co., Ltd, China), as previously described [12]. Statistical analysis Statistical analyses were performed using SPSS software (IBM Corporation, Armonk, New York, USA) (version 19.0). Count data and measurement data of participants’ characteristics were examined by c2 test and t test, respectively. Backward univariate and multivariate logistic regression model was used to assess the relationship between cervical lesions and potential risk factors. P-values were two-sided, and statistical significance was defined as p

Epidemiological Investigation and Risk Factors for Cervical Lesions: Cervical Cancer Screening Among Women in Rural Areas of Henan Province China.

BACKGROUND This cross-sectional study aimed to investigate the prevalence of cervical lesions and evaluate risk factors for cervical intraepithelial n...
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