Prevalence of cervical cancer and feasibility of screening in rural China:a pilot study for the Shanxi Province Cervical Cancer Screening Study

For cervical cancer screening to be feasible in developing countries, it mu st be accurate, inexpensive, and easy to administer. We conducted a pilot s tudy in rural Shanxi Province, People's Republic of China, to determine dis ease prevalence and study feasibility in preparation for a large-scale comp arative trial of 6 screening tests. One-hundred and thirty-six nonpregnant women with no history of hysterectom y, pelvic radiation, or Papanicolaou tests were screened in a rural clinic. Ten percent of the women enrolled reported abnormal vaginal bleeding and 4 5% reported abnormal vaginal discharge. The tests were the Papanicolaou tes t (both conventional and ThinPrep), a self-administered swab test by Hybrid Capture II for high-risk human papillomavirus (HPV), a test for high-risk HPV from residual PreservCyt medium, fluorescence spectroscopy, and visual inspection of the cervix by a clinician. All women also underwent colposcop y and biopsies as the reference standard. Biopsies showed 12 of 136 women had greater than or equal to high-grade squ amous intraepithelial lesions (HGSIL). Screening was completed in 5 half-da y sessions, the procedures went smoothly, and local cooperation was enthusi astic. Disease prevalence in Xiangyuan and Yangcheng Counties, Shanxi Province, ca n be estimated at 8.8% (95% CI, 4.5% to 15.0%). Screening 1000-2000 patient s would be sufficient to detect a 10% difference in accuracy between diagno stic tests. The proposed large-scale trial is feasible.