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Cervical cancer: Epidemiology, risk factors and screening

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Chinese Journal of Cancer Research 2020年第6期32卷 720-728页

作者： Shaokai Zhang Huifeng Xu Luyao Zhang youlin qiao Department of Cancer Epidemiology Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer HospitalHenan Engineering Research Center of Cancer Prevention and ControlHenan International Joint Laboratory of Cancer PreventionZhengzhou 450008China Department of Epidemiology National Cancer CenterChinese Academy of Medical SciencesSchool of Population Medicine and Public HealthPeking Union Medical CollegeBeijing 100021China

Cervical cancer is one of the leading causes of cancer death among females worldwide and its behavior epidemiologically likes a venereal disease of low infectiousness. Early age at first intercourse and multiple sexual partners have been shown to exert strong effects on risk. The wide differences in the incidence among different countries also influenced by the introduction of screening. Although the general picture remains one of decreasing incidence and mortality, there are signs of an increasing cervical cancer risk probably due to changes in sexual behavior. Smoking and human papillomavirus(HPV) 16/18 are currently important issues in a concept of multifactorial, stepwise carcinogenesis at the cervix uteri. Therefore, society-based preventive and control measures, screening activities and HPV vaccination are recommended. Cervical cancer screening methods have evolved from cell morphology observation to molecular testing. High-risk HPV genotyping and liquid-based cytology are common methods which have been widely recommended and used worldwide. In future, accurate,cheap, fast and easy-to-use methods would be more popular. Artificial intelligence also shows to be promising in cervical cancer screening by integrating image recognition with big data technology. Meanwhile, China has achieved numerous breakthroughs in cervical cancer prevention and control which could be a great demonstration for other developing and resource-limited areas. In conclusion, although cervical cancer threatens female health, it could be the first cancer that would be eliminated by human beings with comprehensive preventive and control strategy.

关键词： Cervical cancer epidemiology risk factors screening

Artificial intelligence strengthens cervical cancer screening–present and future

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Cancer Biology & Medicine 2024年第10期21卷 864-879页

作者： Tong Wu Eric Lucas Fanghui Zhao Partha Basu youlin qiao School of Population Medicine and Public Health Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Early Detection Prevention&Infections Branch International Agency for Research on Cancer(WHO)25 avenue Tony GarnierLyon 69007France Department of Cancer Epidemiology National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China

Cervical cancer is a severe threat to women’s *** majority of cervical cancer cases occur in developing *** WHO has proposed screening 70%of women with high-performance tests between 35 and 45 years of age by 2030 to accelerate the elimination of cervical *** to an inadequate health infrastructure and organized screening strategy,most low-and middle-income countries are still far from achieving this *** part of the efforts to increase performance of cervical cancer screening,it is necessary to investigate the most accurate,efficient,and effective methods and *** intelligence(AI)is rapidly expanding its application in cancer screening and diagnosis and deep learning algorithms have offered human-like interpretation capabilities on various medical *** will soon have a more significant role in improving the implementation of cervical cancer screening,management,and *** review aims to report the state of AI with respect to cervical cancer *** discuss the primary AI applications and development of AI technology for image recognition applied to detection of abnormal cytology and cervical neoplastic diseases,as well as the challenges that we anticipate in the future.

关键词： Cervical cancer screening artificial intelligence deep learning algorithms

Development and validation of a predictive model for endocervical curettage in patients referred for colposcopy:A multicenter retrospective diagnostic study in China

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Chinese Journal of Cancer Research 2022年第4期34卷 395-405页

作者： Peng Xue Bingrui Wei Samuel Seery Qing Li Zichen Ye Yu Jiang youlin qiao Department of Epidemiology and Biostatistics School of Population Medicine and Public HealthChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Faculty of Health and Medicine Division of Health ResearchLancaster UniversityLancasterLA14YWUnited Kingdom Diagnosis and Treatment for Cervical Lesions Center Shenzhen Maternity and Child Healthcare HospitalShenzhen 518028China

Objective:This study aimed to develop a nomogram that can predict occult high-grade squamous intraepithelial lesions or worse(HSIL+)and determine the need for endocervical curettage(ECC)in patients referred for ***:This retrospective multicenter study included 4,149 patients who were referred to any one of six tertiary hospitals in China for colposcopy between January 2020 and November 2021 because of abnormal screening *** data were extracted from the medical *** and multivariate logistic regression analyses were performed to identify factors that could predict HSIL+on *** were randomly assigned to a training set or to an internal validation set for performance and comparability *** model was externally validated and tested in patients from two additional *** nomogram was assessed in terms of discrimination and calibration and subjected to decision curve ***:HSIL+was found on ECC in 38.8%(n=388)of *** predictive nomogram included age group,cytology,human papillomavirus(HPV)status,visibility of the cervix and colposcopic *** nomogram had good overall discrimination,which was internally validated[area under the receiver-operator characteristic(AUC),0.839;95%confidence interval(95%CI),0.773-0.904].In terms of external validation,the AUC was 0.843(95%CI,0.773-0.912)for the consecutive sample and 0.843(95%CI,0.783-0.902)for the comparative *** analysis suggested good consistency between predicted and observed *** curve analysis suggested this nomogram would be clinically useful with almost the entire range of threshold ***:This internally and externally validated nomogram can be easily applied and incorporates multiple clinically relevant variables that can be used to identify patients with occult HSIL+who need ECC.

关键词： Cervical cancer colposcopy endocervical curettage nomogram

A study on service capacity of primary medical and health institutions for cervical cancer screening in urban and rural areas in China

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Chinese Journal of Cancer Research 2019年第5期31卷 838-848页

作者： Yang Li Li Ma Chunxia Yang Zhangya Chen Yuqian Zhao Le Dang Jinghe Lang youlin qiao Department of Epidemiology National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Division of Health Information Dissemination Institute of Medical InformationChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100005China Department of Epidemiology Dalian Medical UniversityDalian 116027China Department of Epidemiology and Biostatistics West China School of Public Health and West fourth HospitalSichuan UniversityChengdu 610041China Executive office Taiyuan Health SupervisionTaiyuan 030001China Office of Cancer Prevention and Treatment Sichuan Cancer Hospital&InstituteSichuan Cancer CenterSchool of MedicineUniversity of Electronic Science&Technology of ChinaChengdu 610041China Department of Obstetrics and Gynecology Peking Union Medical College HospitalChinese Academy of Medical Sciences/Peking Union Medical College(CAMS/PUMC)Beijing 100730China

Objective: To provide a decision-making basis for sustainable and effective development of cervical cancer ***: This cross-sectional study assesses the service capacity to conduct cervical cancer screening with a sample of 310 medical staff, medical institutions and affiliated township health centers from 20 countylevel/district-level areas in 14 Chinese provinces in ***: The county-level/district-level institutions were the main prescreening institutions for cervical cancer screening. More medical staff have become engaged in screening, with a significantly higher amounts in urban than in rural areas(P<0.05). The number of human papillomavirus(HPV) testers grew the fastest(by 225% in urban and 125% in rural areas) over the course of the project. HPV testing took less time than cytology to complete the same number of screening tasks in both urban and rural areas. The proportion of mid-level professionals was the highest among the medical staff, 40.0% in urban and 44.7% in rural areas(P=0.406), and most medical staff had a Bachelor’s degree, accounting for 76.3% in urban and 52.0% in rural areas(P<0.001). In urban areas, 75.0% were qualified medical staff, compared with 68.0% in rural areas, among which the lowest proportion was observed for rural cytology inspectors(22.7%). The medical equipment for cervical pathology diagnosis in urban areas was better(P<0.001). HPV testing equipment was relatively adequate(typing test equipment was 70% in urban areas, and non-typing testing equipment was 70% in rural areas).Conclusions: The service capacity of cervical cancer screening is insufficient for the health needs of the Chinese population. HPV testing might be an optimal choice to fill the needs of cervical cancer screening given current Chinese medical health service capacity.

关键词： China cervical cancer screening health service capacity appropriate technology cytology testing HPV testing

A long-term follow-up analysis of associations between tooth loss and multiple cancers in the Linxian General Population cohort

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Journal of the National Cancer Center 2021年第2期1卷 39-43页

作者： Yukiko Yano Jinhu Fan Sanford M.Dawsey youlin qiao Christian *** Division of Cancer Epidemiology and Genetics National Cancer InstituteNational Institutes of Health9609 Medical Center DrMSC 9776BethesdaMD 20892USA Department of Cancer Epidemiology National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China

Poor oral health,indicated by tooth loss and periodontal disease,may be an important risk factor for various *** studies have found inconsistent associations between tooth loss and several cancer ***,we examined the relationship between tooth loss and incident cases of multiple cancers in the Linxian General Population Nutrition Intervention Trial *** this large prospective cohort of over 29,000 participants,there were 3101,1701,626,327,348,and 179 incident esophageal,gastric cardia,gastric noncardia,liver,lung,and colorectal cancer cases,respectively,over 30 years of *** Cox proportional hazards regression models with time-varying covariates were used to estimate hazard ratios(HRs)and 95%confidence intervals(CIs)for the association between tooth loss and cancer outcomes during three time intervals:≤5 years(early),>5 and≤10 years(mid),>10 years(late).Tooth loss was assessed as quartiles of the number of lost teeth in excess of the loess-smoothed,age-specific median number of teeth *** esophageal cancer,the increase in risk associated with the highest quartile of tooth loss was 25%(95%CI:1.02,1.52)in the mid time interval,but the association weakened *** gastric cardia cancer,the increase in risk associated with the highest quartile of tooth loss was 1.34 in both the early(95%CI:1.06,1.71)and mid time intervals(95%CI:1.02,1.76),with no significant associations in the late *** noncardia cancer was only associated with the second quartile of tooth loss in the late time interval(HR=1.54;95%CI:1.16,2.04).All associations between tooth loss and liver,lung,and colorectal cancers were *** loss was associated with risk of esophageal and gastric cancers in this updated analysis from the cohort.

关键词： Oral health Tooth loss Cancer

Estimation of economic burden throughout course of cervical squamous intraepithelial lesion and cervical cancer in China:A nationwide multicenter cross-sectional study

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Chinese Journal of Cancer Research 2023年第6期35卷 675-685页

作者： Hao Chen Xuelian Zhao Shangying Hu Tingting You Changfa Xia Meng Gao Mingjie Dong youlin qiao Fanghui Zhao Department of Cancer Epidemiology National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Office of Cancer Screening National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China School of Population Medicine and Public Health Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Center for Global Health School of Population Medicine and Public HealthChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China

Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and ***: A nationwide multicenter, cross-sectional, hospital-based survey was conducted in 26 qualified hospitals across seven administrative regions of China. We investigated females who had been pathologically diagnosed with SIL and cervical cancer, and included five disease courses(“diagnosis”, “initial treatment”,“chemoradiotherapy”, “follow-up” and “recurrence/progression/metastasis”) to estimate the total costs. The median and interquartile range(IQR) of total costs(including direct medical, direct non-medical, and indirect costs), reimbursement rate by medical insurance, and catastrophic health expenditures in every clinical stage were ***: A total of 3,471 patients in different clinical stages were analyzed, including low-grade SIL(LSIL)(n=549), high-grade SIL(HSIL)(n=803), cervical cancer stage ⅠA(n=226), ⅠB(n=610), ⅡA(n=487), ⅡB(n=282), Ⅲ(n=452) and Ⅳ(n=62). In urban areas, the estimated total costs of LSIL and HSIL were $1,637.7(IQR:$956.4-$2,669.2) and $2,467.1(IQR:$1,579.1-$3,762.3), while in rural areas the costs were $459.0(IQR:$167.7-$1,330.3) and $1,230.5(IQR:$560.6-$2,104.5), respectively. For patients with cervical cancer stage ⅠA,ⅠB, ⅡA, ⅡB, and Ⅲ-Ⅳ, the total costs were $15,034.9(IQR:$11,083.4-$21,632.4), $19,438.6(IQR:$14,060.0-$26,505.9), $22,968.8(IQR:$16,068.8-$34,615.9), $26,936.0(IQR:$18,176.6-$41,386.0) and $27,332.6(IQR:$17,538.7-$44,897.0), respectively. Medical insurance covered 43%-55% of direct medical costs for cervical cancer patients, while the coverage for SIL patients was 19%-43%. For most cervical cancer patients, the expense was catastrophic, and the extent of catastrophic health expenditure was about twice large for rural patients than that for urban patients in each ***: The e

关键词： Squamous intraepithelial lesion cervical cancer economic burden medicare catastrophic health expenditures

Preventive Oncology International:A brief history of HPV self-collected vaginal specimens for cervical cancer screening

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Gynecology and Obstetrics Clinical Medicine 2023年第3期3卷 144-148页

作者： Jerome L.Belinson Robert G.Pretorius Ruifang Wu youlin qiao Preventive Oncology International Inc.Women's Health InstituteCleveland ClinicUSA Department of Ob/Gyn Southern California Permanente GroupFontanaCAUSA Department of Ob/Gyn Peking University Shenzhen HospitalShenzhenChina School of Population Medicine and Public Health Chinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing100005PR China

Since 1998,Preventive Oncology International,Inc.(POI)has been at the forefront of studying human papillomavirus(HPV)self-collection for cervical cancer screening,with a significant focus in *** multiple clinical trials over the past 25 years,POI has explored various aspects related to self-collection *** 2004–2006,POI established that self-collection could be equivalent to direct endocervical ***,a large randomized trial involving 10,000 patients in 2010 further confirmed that self-collected vaginal specimens,tested for high-risk HPV(hrHPV)using a PCR-based assay with high analytic sensitivity,could effectively replace endocervical specimens with minimal loss of sensitivity and a slight decrease in *** the years,POI's research has encompassed several crucial topics,including patient acceptance,the development of new cost-effective,simpler,and faster assays,exploring different collection devices,devising efficient methods of specimen transport,and implementing population-based screening *** findings strongly support the integration of self-collection methodologies into cervical cancer control programs worldwide,particularly in medically underserved *** HPV self-collection continues to evolve,ongoing research and innovations are expected to play a pivotal role in achieving the global mission of combating cervical cancer.

关键词： Human papillomavirus(HPV) Self-collection Self-sampling Cervical cancer screening

Value of multi-quadrants biopsy:Pooled analysis of 11 population-based cervical cancer screening studies

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Chinese Journal of Cancer Research 2020年第3期32卷 383-394页

作者： Yuqian Zhao Fanghui Zhao Shangying Hu Xun Zhang Wenhua Zhang Qinjing Pan Julia C Gage Rengaswamy Sankaranarayanan youlin qiao Department of Cancer Epidemiology National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Research Center of Cancer Prevention Sichuan Cancer Hospital&InstituteSichuan Cancer CenterSchool of MedicineUniversity of Electronic Science and Technology of ChinaChengdu 610041China Department of Pathology National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of Gynaecology National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Division of Cancer Epidemiology and Genetics National Cancer InstituteRockville 20852USA Research Triangle Institute Global India New Delhi 110019India Screening Group Section of Early Detection and PreventionInternational Agency for Research on CancerLyon 69372France

Objective:The accuracy of colposcopy-guided biopsy is key to the success of colposcopic triage in cervical cancer screening ***,there is no widely adopted biopsy guideline up to *** study aimed to determine whether multi-quadrants biopsy improves the yield of cervical ***:Eleven population-based cervical cancer screening studies were conducted in ***,highrisk human papillomavirus(hrHPV)testing and visual inspection were performed for primary *** positive on one or more tests were referred for colposcopy and *** proportion of detected cervical intraepithelial neoplasia(CIN)2+and yields by quadrant lesion-targeted biopsy or 4-quadrant random biopsy were ***:Among 4,923 females included,1,606 had quadrant lesion-targeted biopsy,and 3,317 had 4-quadrant random *** cumulative CIN2+yield increased from 0.10 for only one quadrant-targeted biopsy to 0.21,0.34,and 0.58 for at most two,three and four quadrants targeted *** hrHPV positive females with high-grade squamous intraepithelial lesion(HSIL)+cytology,the cumulative CIN2+yield of a second targeted biopsy in another quadrant was significantly increased(P<0.05).Among hrHPV-negative females,the yield of 4-quadrant random biopsies was 0.005,and the yield by lesion-targeted biopsies was *** hrHPV positive females who had 4-quadrant random biopsy,the additional CIN2+yield for HSIL+,low-grade squamous intraepithelial lesion(LSIL)cytology,or abnormal visual inspection via acetic acid and Lugol’s iodine(VIA/VILI)were 0.46,0.11,***:A 4-quadrant random biopsy is recommended only for hrHPV positive females with HSIL cytology,and is acceptable if hrHPV positive with LSIL cytology or with abnormal VIA/*** findings add evidences for an objective and practical biopsy standard to guide colposcopy in cervical cancer screening programs in low-and middle-income countries.

关键词： Cervical cancer and precancerous lesion colposcopy low-and middle-income countries multi-quadrant biopsy screening

适宜发展中国家与地区的宫颈癌快速筛查技术的研究及意义

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中华预防医学杂志 2015年第2期49卷 110-111页

作者：乔友林中国医学科学院北京协和医学院肿瘤医院北京100021

中国医学科学院肿瘤医院为首的团队开发了适宜发展中国家与地区的宫颈癌快速筛查技术，即人乳头瘤病毒（HPV）DNA检测技术——careHPV检测技术。该检测技术是国际上首次研发成功的一种简单、快速、准确、安全并且成本较低的技术，并且... 详细信息

中国医学科学院肿瘤医院为首的团队开发了适宜发展中国家与地区的宫颈癌快速筛查技术，即人乳头瘤病毒（HPV）DNA检测技术——careHPV检测技术。该检测技术是国际上首次研发成功的一种简单、快速、准确、安全并且成本较低的技术，并且首次以临床疾病结局为终点指标，验证了careHPV检测技术在人群中筛查宫颈癌的准确性，与目前采用的标准HPV检测方法和细胞学检测结果接近，高于醋酸染色肉眼观察法（VIA）。careHPV检测技术的推广和应用将有助于促进我国并带动其他发展中国家的宫颈癌防治工作，加快缩短发展中国家与发达国家在宫颈癌防治方面的差距，对于全球降低宫颈癌发病率、死亡率具有重要意义。

关键词：宫颈肿瘤快速筛查 HPV CareHPV