Burden of cervical cancer and role of screening in India.
Burden of cervical cancer and role of screening in India.
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DOI：
10.4103/0971-5851.195751
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发表时间：
2016-10
期刊：
影响因子：
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通讯作者：
Balasubramaniam G
中科院分区：
文献类型：
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作者：
Bobdey S;Sathwara J;Jain A;Balasubramaniam G
宫颈癌是导致妇女癌症死亡的主要原因，其全球负担的四分之一以上是由发展中国家造成的。在印度，尽管数字高得惊人，但没有全国性的政府资助的筛查计划。这项研究旨在评估印度宫颈癌的负担，并审查现有宫颈癌筛查工具的性能特点，以便为在资源匮乏的现场环境中应用最实用的筛查测试提供循证建议。计算机检索Medline和Web of Science电子数据库1990-01-2015-12，检索词“宫颈癌”、“筛查”、“早期检测”、“宫颈细胞学”、“目视检查”及其对应的网格词，并结合布尔运算符“OR，AND”，限定文章语言种类为中文。两位作者独立选择了以英语发表并在印度进行的研究。共有11项研究被认为是相关的，符合纳入本研究的条件。在印度，宫颈癌约占所有女性癌症的6%-29%。不同地区的宫颈癌年龄调整发病率差别很大；最高的是米佐拉姆州的23.07/10万，最低的是迪布鲁加尔区的4.91/10万。冰醋酸(VIA)肉眼检查、VIA放大、卢高氏碘(VILI)肉眼检查、细胞学(巴氏涂片)、人乳头瘤病毒DNA检查的灵敏度和特异度分别为67.65%和84.32%、65.36%和85.76%、78.27%和87.10%、62.11%和93.51%、77.81%和91.54%。在发展中国家，由于缺乏必要的基础设施和质量控制，高质量的细胞学筛查可能无法大规模实施。因此，在印度等资源匮乏的国家，应采用VIA/VILI等基于视觉筛查测试的宫颈癌筛查计划，作为初级卫生保健体系的组成部分。
Cervical cancer is a major cause of cancer mortality in women and more than a quarter of its global burden is contributed by developing countries. In India, in spite of alarmingly high figures, there is no nationwide government-sponsored screening program. This study was conducted to assess the burden of cervical cancer in India and review the performance characteristics of available cervical cancer screening tools, so as to provide evidence-based recommendations for application of most practically suited screening test to be used in resource-poor field settings. MEDLINE and Web of Science electronic database were searched from January 1990 to December 2015, using the keywords such as “cervical cancer”, “screening”, “early detection”, “cervical cytology” and “visual inspection”, and their corresponding MeSH terms in combination with Boolean operators “OR, AND.” Two authors independently selected studies that are published in English and conducted in India. A total of 11 studies were found to be relevant and eligible to be included in the present study. In India, cervical cancer contributes to approximately 6–29% of all cancers in women. The age-adjusted incidence rate of cervical cancer varies widely among registries; highest is 23.07/100,000 in Mizoram state and the lowest is 4.91/100,000 in Dibrugarh district. The pooled estimates of sensitivity and specificity of visual inspection with acetic acid (VIA), magnified VIA, visual inspection with Lugol's iodine (VILI), cytology (Pap smear), and human papillomavirus DNA were found to be 67.65% and 84.32%, 65.36% and 85.76%, 78.27% and 87.10%, 62.11% and 93.51%, and 77.81% and 91.54%, respectively. In developing countries because of lack of necessary infrastructure and quality control, high-quality cytology screening may not be feasible for wide-scale implementation. Hence, cervical cancer screening program based on visual screening test such as VIA/VILI should be adopted as an integral part of primary health-care setup in resource-poor countries like India.