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中华妇幼临床医学杂志(电子版) ›› 2014, Vol. 10 ›› Issue (06) : 757 -761. doi: 10.3877/cma.j.issn.1673-5250.2014.06.013

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论著

宫颈癌筛查工作评价指标的比较研究
韩历丽1, 赵同香2, 邓小红3,*,*()   
  1. 1. 100026 首都医科大学附属北京妇产医院北京妇幼保健院保健部
    2. 北京大学首钢医院科研处
    3. 北京市卫生局
  • 收稿日期:2014-05-15 修回日期:2014-10-20 出版日期:2014-12-01
  • 通信作者: 邓小红

Comparative Study of Evaluating Indicators for Cervical Cancer Mass Screening

Lili Han1, Tongxiang Zhao2, Xiaohong Deng3()   

  1. 1. Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026 , China
  • Received:2014-05-15 Revised:2014-10-20 Published:2014-12-01
  • Corresponding author: Xiaohong Deng
  • About author:
    (Corresponding author : Deng Xiaohong,Email : )
引用本文:

韩历丽, 赵同香, 邓小红. 宫颈癌筛查工作评价指标的比较研究[J/OL]. 中华妇幼临床医学杂志(电子版), 2014, 10(06): 757-761.

Lili Han, Tongxiang Zhao, Xiaohong Deng. Comparative Study of Evaluating Indicators for Cervical Cancer Mass Screening[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2014, 10(06): 757-761.

目的

探讨将晚期宫颈癌患者的临床病历资料作为宫颈癌筛查工作质量评价指标的可行性。

方法

选择2007年1月至2010年12月2 092例北京市户籍新发宫颈癌患者(12 ~ 93岁)的临床病历资料(数据由北京市肿瘤防治研究办公室提供)以及从北京妇幼保健网络信息系统获得的2008 – 2009年(宫颈癌第1个筛查周期)北京市所管辖18个区县进行宫颈癌筛查的728 704例适龄妇女(25~64岁)的病历资料(其中确诊为宫颈癌患者为89例)为研究对象。采用回顾性调查法将2007 – 2010年北京市新发宫颈癌患者临床病历资料与同期北京市宫颈癌筛查登记记录进行比对,追踪筛查中漏诊晚期宫颈癌患者的临床病历资料。分析宫颈癌发生率、病死率、筛查早期诊断率、检出率、参与率及晚期宫颈癌检出率等指标作为宫颈癌筛查工作评价指标的适用条件及可行性。

结果

2007年1月至2010年12月北京户籍新发宫颈癌患者中,有明确临床分期者为1 663例(79.49%,1 663/2 092),其中晚期宫颈癌患者为442例(26.58%,442/1 663)。北京妇幼保健网络信息系统中显示,2008 – 2009年间确诊为晚期宫颈癌的98例患者中,参加北京市宫颈癌筛查者为24例,其中,筛查时宫颈细胞学检查未见异常,但筛查后4~20个月内确诊为晚期宫颈癌患者为5例,且主要集中在4个区县。按照目前北京宫颈癌筛查主要采用的评价指标(筛查早期诊断率、癌前病变及癌检出率、筛查参与率),发生漏诊的4个区县的筛查效果排名位居18个区县前列。

结论

晚期宫颈癌发病数据与宫颈癌发生率、病死率、筛查早期诊断率、检出率、参与率等评价指标各有利弊,晚期宫颈癌患者临床病历资料较易获取,可作为评价开展宫颈癌筛查地区及岗位人员筛查工作质量的考核指标。

Objective

To explore the rational and feasible evaluation indicators of mass screening of new-onset cervical cancer.

Methods

A total of 2 092 medical records of new-onset cervical cancer in Beijing from January 2007 to December 2010, as well as cervical cancer incidence and mortality from January 2000 to December 2010 in Beijing were provided by Beijing Office for Cancer Prevention and Control. Meanwhile, the clinical data of mass screening of cervical cancer during the year of 2008 and 2009 were collected from Maternal Child Network Information System. A co-analysis were made retrospectively. The different evaluation indicators (incidence rates, mortality, early stage diagnosis rates, detection rates, participate rates and early diagnosis rates) of cervical cancer screening were compared.

Results

Among 2 092 new-onset cervical cancer patients from January 2007 to December 2010, 1 663 cases (79.49%,1 663/2 092) had a clear clinical stage and 442 cases (26.58%, 442/1 663) were advanced cervical cancer patients. By checking the medical records of advanced cervical cancer of the hospitals and comparing with the data of cervical cancer screening from the year of 2008 and 2009, it showed that 24 cases with advanced cervical cancer participated in the cervical cancer screening, and 5 cases were missed. Those 5 cases mainly concentrated in 4 counties in Beijing. According to the current evaluation indicators of cervical cancer, screening effects of the four counties ranked the forefront among the whole 18 counties.

Conclusions

There are pros and cons between advanced cervical cancer incidence data, incidence rate, mortality, early diagnosis rate, detection rate, participate rate of cervical cancer. But by comparison with the advanced cervical cancer incidence data provided by the hospital medical records and cervical cancer screening data, we can find out misdiagnosed advanced cervical cancer patients, which can evaluate the quality of cervical cancer screening.

表1 2008 – 2009年度北京市各区县宫颈癌筛查参与率、检出率、早期诊断率分布情况
Table 1 The distribution of participate rates, detection rates and early diagnosis rates of 18 counties between the year of 2008 and 2009
表2 北京市各区县宫颈癌筛查效果比较
Table 2 Comparison of the cervical cancer screening effects among different counties in Beijing
图1 北京市宫颈癌发生率和死亡率变化情况(竖线表示2008年与2009年为筛查年度)
Figure 1 Incidence and mortality change of uterine cervical cancer in Beijing (Vertical line means screening year)
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