A study on service capacity of primary medical and health institutions for cervical cancer screening in urban and rural areas in China

Yang Li; Li Ma; Chunxia Yang; Zhangya Chen; Yuqian Zhao; Le Dang; Jinghe Lang; Youlin Qiao

doi:10.21147/j.issn.1000-9604.2019.05.13

A study on service capacity of primary medical and health institutions for cervical cancer screening in urban and rural areas in China

Chin J Cancer Res. 2019 Oct;31(5):838-848. doi: 10.21147/j.issn.1000-9604.2019.05.13.

Authors

Yang Li^{1

2}, Li Ma³, Chunxia Yang⁴, Zhangya Chen⁵, Yuqian Zhao⁶, Le Dang¹, Jinghe Lang⁷, Youlin Qiao¹

Affiliations

¹ Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
² Division of Health Information Dissemination, Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China.
³ Department of Epidemiology, Dalian Medical University, Dalian 116027, China.
⁴ Department of Epidemiology and Biostatistics, West China School of Public Health and West fourth Hospital, Sichuan University, Chengdu 610041, China.
⁵ Executive office, Taiyuan Health Supervision, Taiyuan 030001, China.
⁶ Office of Cancer Prevention and Treatment, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science & Technology of China, Chengdu 610041, China.
⁷ Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College (CAMS/PUMC), Beijing 100730, China.

PMID: 31814687
PMCID: PMC6856697
DOI: 10.21147/j.issn.1000-9604.2019.05.13

Abstract

Objective: To provide a decision-making basis for sustainable and effective development of cervical cancer screening.

Methods: This cross-sectional study assesses the service capacity to conduct cervical cancer screening with a sample of 310 medical staff, medical institutions and affiliated township health centers from 20 county-level/district-level areas in 14 Chinese provinces in 2016.

Results: The county-level/district-level institutions were the main prescreening institutions for cervical cancer screening. More medical staff have become engaged in screening, with a significantly higher amounts in urban than in rural areas (P<0.05). The number of human papillomavirus (HPV) testers grew the fastest (by 225% in urban and 125% in rural areas) over the course of the project. HPV testing took less time than cytology to complete the same number of screening tasks in both urban and rural areas. The proportion of mid-level professionals was the highest among the medical staff, 40.0% in urban and 44.7% in rural areas (P=0.406), and most medical staff had a Bachelor's degree, accounting for 76.3% in urban and 52.0% in rural areas (P<0.001). In urban areas, 75.0% were qualified medical staff, compared with 68.0% in rural areas, among which the lowest proportion was observed for rural cytology inspectors (22.7%). The medical equipment for cervical pathology diagnosis in urban areas was better (P<0.001). HPV testing equipment was relatively adequate (typing test equipment was 70% in urban areas, and non-typing testing equipment was 70% in rural areas).

Conclusions: The service capacity of cervical cancer screening is insufficient for the health needs of the Chinese population. HPV testing might be an optimal choice to fill the needs of cervical cancer screening given current Chinese medical health service capacity.

Keywords: China; HPV testing; appropriate technology; cervical cancer screening; cytology testing; health service capacity.