Chou Hung-Hsueh, Huang Huei-Jean, Cheng Hui-Hsin, Chang Chee-Jen, Yang Lan-Yan, Huang Chu-Chun, Chang Wei-Yang, Hsueh Swei, Chao Angel, Wang Chin-Jung, Tang Yun-Hsin, Lin Cheng-Tao, Qiu Jian-Tai, Chen Min-Yu, Chen Chao-Yu, Huang Kuan-Gen, Tsai Tzu-Chun, Chang Ting-Chang, Lai Chyong-Huey
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
J Formos Med Assoc. 2016 Dec;115(12):1089-1096. doi: 10.1016/j.jfma.2015.10.014. Epub 2015 Dec 23.
BACKGROUND/PURPOSE: Under-utilization of Papanicolaou (Pap) smear causes a gap in the prevention of cervical neoplasms. A prospective population-based study was conducted investigating whether a self-sampling human papillomavirus (HPV) test was feasible for under-users of Pap smear and factors associated with under-screening in Taiwan.
Women not having Pap smear screening for > 5 years were invited to participate in this study. Invitation letters and educational brochures were mailed to 4% of randomly selected eligible women from Taoyuan City, Taiwan, and responders received an HPV self-sampling kit. Those with HPV-positive results were recalled for a Pap smear and colposcopy.
Between March 2010 and June 2012, 10,693 women were invited, 354 responded (3.3%), and 282 (2.6%) gave valid informed consent, answered the questionnaire, and submitted HPV samples. The median age of enrolled women was 48.1 years. Forty-seven women (16.7%) had a positive HPV test, and 14 women accepted further survey to find two CIN2+. Another two cases of CIN2+ were identified from a national registry database. The cost of direct mailing self-samplers was less than that done on request (from NT$434,866 to NT$164,229, response rate of 5% to 15%, respectively, versus NT$683,957 for detecting 1 CIN2+). Reasons for not attending screening included lack of time, embarrassment, assumed low risk, fear of positive results, and perceived potential pain. Among the responders, 90.8% found the method acceptable.
Our study indicated that different approaches (e.g., direct mailing self-samplers to under-users and/or various educational interventions) must be explored to improve coverage in populations with culture characteristics similar to Taiwan.
背景/目的：巴氏涂片检查利用不足导致宫颈癌预防出现缺口。开展了一项基于人群的前瞻性研究，调查人乳头瘤病毒（HPV）自检对未充分接受巴氏涂片检查者是否可行，以及台湾地区与筛查不足相关的因素。
邀请5年以上未进行巴氏涂片筛查的女性参与本研究。向台湾桃园市4%随机抽取的符合条件女性邮寄邀请函和教育手册，回复者会收到HPV自检试剂盒。HPV检测结果呈阳性者会被召回进行巴氏涂片检查和阴道镜检查。
2010年3月至2012年6月期间，共邀请了10693名女性，354人回复（3.3%），282人（2.6%）给出有效知情同意书、回答问卷并提交了HPV样本。入选女性的中位年龄为48.1岁。47名女性（16.7%）HPV检测呈阳性，14名女性接受了进一步检查，发现2例高级别鳞状上皮内病变（CIN2+）。另外2例CIN2+病例是从国家登记数据库中识别出来的。直接邮寄自检样本的成本低于按需检测（分别从新台币434866元降至新台币164229元，回复率从5%提高到15%，而检测出1例CIN2+的成本为新台币683957元）。未参加筛查的原因包括没时间、难为情、认为风险低、害怕结果呈阳性以及感觉可能会疼痛。在回复者中，90.8%认为该方法可以接受。
我们的研究表明，必须探索不同方法（如直接向未充分接受检查者邮寄自检样本和/或开展各种教育干预措施），以提高与台湾地区文化特征相似人群的筛查覆盖率。
