Nellai Cancer Care Center, Udhavum Ullangal, Tirunelveli, Tamil Nadu, India.
Fenivi Research Solutions, Chennai, Tamil Nadu, India.
J Epidemiol Glob Health. 2020 Mar;10(1):28-35. doi: 10.2991/jegh.k.191111.001.
In India, cervical cancer screening is conducted at various levels; however, after screening, the adherence to the cancer care continuum is barely understood. This study evaluated a community-based cancer screening program conducted in a rural setting (Tirunelveli and Tuticorin districts) in South India and reviewed the completion of care continuum. In this longitudinal descriptive study involving secondary data collection, data from the case records of 2192 women who were consecutively screened between March 2015 and May 2016 were included. All women underwent conventional cytology-based screening (Pap smear) and Visual Inspection with Acetic Acid (VIA). Those for whom either test was positive were referred for histopathological confirmation. Patients with confirmed precancerous conditions and unsatisfactory Pap smears were referred for further management. In total, 2192 women were screened [age range, 17-69 years; mean (standard deviation), 39.2 (8.5)]. Common symptom and sign were white discharge per vaginum (34.9%) and cervical erosion (34.4%), respectively. The VIA was positive for 24% (523/2178; 14 women did not cooperate for VIA) and 113 (5.1%) had epithelial cell abnormality in the Pap smear test. Per histopathology findings, one woman had non-keratinizing squamous cell carcinoma. Seven, three, and four had cervical intraepithelial neoplasia I, II and III, respectively. Of 2192, 807 were eligible for referral (597 had positive results on either Pap or VIA). Among the 807 women referred, only 74 (9.2%) women visited the referral center. The follow-up rate was very poor accounting to fragmentation of care continuum. The success of the screening program depends on the completion of the care continuum.
在印度，宫颈癌筛查在不同层面进行；然而，在筛查后，对癌症关怀连续体的遵循情况几乎不被了解。本研究评估了在印度南部农村地区（Tirunelveli 和 Tuticorin 区）进行的一项基于社区的癌症筛查计划，并审查了完成关怀连续体的情况。在这项涉及二次数据收集的纵向描述性研究中，纳入了 2015 年 3 月至 2016 年 5 月连续筛查的 2192 名女性的病例记录数据。所有女性均接受常规细胞学筛查（巴氏涂片）和醋酸视觉检查（VIA）。对于任何一项检测呈阳性的女性，均被转诊进行组织病理学确认。对确诊为癌前病变和巴氏涂片不满意的患者进行进一步管理。共有 2192 名女性接受了筛查[年龄范围 17-69 岁；平均（标准差）39.2（8.5）]。常见的症状和体征分别为阴道白色分泌物（34.9%）和宫颈糜烂（34.4%）。VIA 阳性率为 24%（523/2178；14 名女性不合作进行 VIA），113 名（5.1%）巴氏涂片检查显示上皮细胞异常。根据组织病理学检查结果，1 名女性患有非角化鳞状细胞癌。7 名、3 名和 4 名女性分别患有宫颈上皮内瘤变 I、II 和 III。在 2192 名女性中，有 807 名符合转诊条件（597 名在巴氏涂片或 VIA 检查中结果阳性）。在转诊的 807 名女性中，只有 74 名（9.2%）女性前往转诊中心就诊。随访率非常低，这表明关怀连续体的断裂。筛查计划的成功取决于关怀连续体的完成情况。
