Cervical cancer screening in China is largely limited to occasional opportunistic screening in urban centers. The current study reports histopathologic follow-up and human papillomavirus (HPV) results in women with high-grade squamous intraepithelial lesion (HSIL) Papanicolaou (Pap) tests reported at the largest academic women's hospital in China and compares these findings with those of published Western studies among frequently screened women.
A retrospective cohort study documented HSIL Pap tests, patient age, HPV results, and histopathologic follow-up from 2011 through 2015 in the Obstetrics and Gynecology Hospital of Fudan University (OGHFU) in Shanghai, China. Of 886,122 Pap test results, 4269 (0.48%) reported HSIL. Histopathologic follow-up was available for 2351 cases and HPV results were available for 2092 cases.
HSIL reporting rates increased with patient age from 0.16% at age <30 years to 0.58% at ages 30 to 49 years and 0.75% at age ≥50 years. HSIL rates were found to be significantly higher for women tested using liquid-based cytology (0.52%-0.55%) compared with conventional Pap tests (0.19%). Among 2351 cases with histopathologic follow-up, cervical intraepithelial neoplasia of type 2/3 was diagnosed in 74.1% of cases and squamous cell carcinoma in 14.2% of cases. Squamous cell carcinoma was diagnosed in 22.8% of patients aged ≥50 years who underwent biopsy. HPV-positive HSIL rates using 3 different HPV tests ranged from 88.1% to 93.9%.
At OGHFU, the finding of an increase in HSIL cytology rates with increasing patient age contrasted with a finding of decreasing HSIL rates with increasing age previously reported in regularly screened cotested patients in the United States. The increasing HSIL rates with older age and high rates of cervical cancer diagnoses noted at OGHFU appear to be best explained by the absence of consistent intraepithelial lesion ablation achievable with frequent screening and treatment. Cancer Cytopathol 2017;125:947-53. © 2017 American Cancer Society.