Ueda Yutaka, Kawana Kei, Yanaihara Nozomu, Banno Kouji, Chhit Maryan, Uy Kyna, Kruy Leangsim, Sann Chan S, Ishioka-Kanda Miwa, Akaba Hiroki, Matsumoto Yasuyo, Fujita Noriko, Yano Testu, Koum Kanal, Okamoto Aikou, Kimura Tadashi
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan.
J Obstet Gynaecol Res. 2019 Jul;45(7):1260-1267. doi: 10.1111/jog.13968. Epub 2019 Apr 11.
In Cambodia, the Japan Society of Obstetrics and Gynecology and the Cambodian Society of Gynecology and Obstetrics have an on-going project, started in 2015, for cervical cancer prevention and treatment. The project, currently aimed at factory workers, includes a women's health education program that leads into cervical cancer prevention by establishment of a system for early detection and treatment. It begins by health education, screening for human papillomavirus (HPV), followed by colposcopy and quicker treatment of earlier precursor lesions.
Rates for participant screening, HPV test positivity, cervical intraepithelial neoplasia (CIN) detection and distribution of HPV types were compared between two screening programs, factory-based and hospital-based. Some HPV test samples were divided into two, one of which was sent to Japan for a quality-control check of the Cambodian testing.
The factory-based participant screening rate was 19% (128/681). HPV was detected more frequently in the factory-based program participants (12%) than in the hospital-based program participants (5%). Unfortunately, however, the rate of receiving proper secondary colposcopy screening among the HPV-positive females was significantly higher in the hospital-based program (94%) than the factory-based program (40%) (P < 0.001). The Cambodian laboratory HPV testing accuracy was 92.6%. HPV types demonstrated no significant difference between the two prevention programs.
We could successfully introduce HPV-based screening, starting from health education. However, low rate of screening, especially secondary screening for HPV positive factory workers was identified. Also, HPV testing could be further improved for accuracy through close monitoring.
在柬埔寨，日本妇产科学会和柬埔寨妇产科学会于2015年启动了一个宫颈癌防治项目。该项目目前针对工厂工人，包括一个妇女健康教育项目，通过建立早期检测和治疗系统来预防宫颈癌。项目从健康教育开始，进行人乳头瘤病毒（HPV）筛查，随后进行阴道镜检查，并对早期癌前病变进行更快的治疗。
比较了基于工厂和基于医院的两种筛查项目的参与者筛查率、HPV检测阳性率、宫颈上皮内瘤变（CIN）检测率以及HPV类型分布。一些HPV检测样本被分成两份，其中一份被送往日本进行柬埔寨检测的质量控制检查。
基于工厂的参与者筛查率为19%（128/681）。基于工厂的项目参与者中HPV检测阳性的频率（12%）高于基于医院的项目参与者（5%）。然而，不幸的是，在HPV阳性女性中，基于医院的项目接受适当二次阴道镜筛查的比例（94%）显著高于基于工厂的项目（40%）（P<0.001）。柬埔寨实验室HPV检测准确率为92.6%。两种预防项目之间的HPV类型没有显著差异。
我们能够从健康教育开始成功引入基于HPV的筛查。然而，筛查率较低，尤其是对HPV阳性工厂工人的二次筛查。此外，通过密切监测，HPV检测的准确性可以进一步提高。
