Performance of Government-Financed Cervical Cancer Screening in Hunan, China and Optimization of Triage Strategies.

Abstract

Objectives: Cervical cancer is a preventable and manageable public health concern. This study aimed to evaluate the performance of a government-financed cervical cancer screening program and to discuss optimal primary screening approach and triage strategies for large-scale population screening.

Methods: This population-based study was conducted from 2015 to 2020 and included 6,373,279 eligible women. The performance of the cervical cancer screening program in Hunan Province was evaluated by comparing cancer incidence and mortality rates. The screening powers of primary human papillomavirus (HPV) testing and cytology were compared by calculating positive outcomes and cervical intraepithelial neoplasia 2 or worse (CIN2+) detection rates. Triage strategies for individuals positive for HPV-16/18 after primary HPV testing were discussed by comparing the CIN2+ detection rates and associated costs.

Results: The cervical cancer screening program has contributed to lower cancer mortality rates in Hunan Province. The HPV testing showed a higher CIN2+ detection rate than cytology as the primary screening approach (0.604% vs. 0.324%). For individuals positive for HPV-16/18, reflex cytology demonstrated a higher CIN2+ detection rate than direct colposcopy (51.11% vs 41.25%), although it was more expensive. For individuals with high-risk HPV types other than HPV-16/18, direct colposcopy exhibited a similar CIN2+ detection power as reflex cytology, but cost less.

Conclusions: The cervical cancer screening program should be expanded because the benefits outweigh the costs. Statistical data indicate that HPV testing is a cost-effective preliminary screening approach for large-scale population screening.