Early detection of precancerous lesions during screening can lead to effective treatment before disease progression

　　In April 2017, the free screening project for "two cancers" for urban and rural women in Zhejiang Province was officially launched, and it has been implemented for nearly 5 years.

　　The so-called "two cancers" refer to cervical cancer and breast cancer, which are the top two in the incidence of gynecological cancers.

According to the implementation plan, as long as the 35-64-year-old women with Zhejiang household registration who participate in the basic medical insurance for urban and rural residents in Zhejiang Province can enjoy free "two cancer" screenings every 5 years.

　　Shen Yuanming, deputy chief physician of the Department of Gynecological Oncology, Zhejiang University Women's Hospital, said that in recent years, the number of patients treated for cervical precancerous lesions in the hospital's cervical disease clinics has increased steadily, indicating that more and more women are detecting precancerous lesions in time during screening, and the disease worsens. received treatment before.

　　At the same time, she found that there are two types of women who are most likely to be missed in the "two cancers" screening - rural women and migrant women, whose poor health awareness and job mobility make it difficult for them to benefit from it.

　　Village cadres go door-to-door

　　The old aunt still resists the inspection

　　Aunt Liu, who is in her early 60s, lives alone in the countryside. Two years ago, it was her turn to be screened for free "two cancers" in her village. At any rate, she finally arrived at the screening point, but when she saw the inspection items, she was shaken again——

　　"It's all a woman's privacy. How can I let others touch it? I won't get women's disease." In the end, she only had a breast ultrasound.

　　At the end of last year, Aunt Liu had vaginal bleeding and told her daughter after hesitation.

After examination in the local hospital, she was diagnosed with cervical cancer, which had progressed to a locally advanced stage, and was transferred to the Women's Hospital of Zhejiang University due to her serious condition.

　　Shen Yuanming sighed that if she had done cervical cancer screening, she might have been able to detect precancerous lesions or at the early stage, and she could be treated with surgery.

At the time of her diagnosis, the diameter of the local tumor was more than 4 cm, and the risk of surgery was greatly increased. She could not be cured by surgery alone, and needed comprehensive treatment such as radiotherapy and chemotherapy to better control the disease.

"In our hospital, early cervical cancer is mostly curable, and the five-year survival rate can reach more than 90%, and there is a chance to preserve fertility. But if it progresses to locally advanced stage or stage III-IV, the five-year survival rate is only about 40%~ 70%."

　　In addition, urban migrant women with unstable living places and high job mobility are also prone to miss the "two cancers" screening.

　　The Hologic Global Women's Health Index report is a global comparative study of women's health covering multiple health issues critical to improving women's health, quality of life and life expectancy.

　　The report shows that 25% of Chinese women with primary education and below are unable to engage in normal activities due to health problems; compared to 12% of women with secondary education and 2% of women with higher education due to health problems Unable to engage in normal activities.

　　Shen Yuanming said that most rural women and migrant women have primary education or below, so he calls for strengthening the popularization and education of diseases for these two groups of people and increasing their enthusiasm for participating in the "two cancers" screening.

　　Mother of second child who was vaccinated early

　　Still haven't escaped the fate of cervical cancer

　　HPV virus is the culprit of the vast majority of cervical cancer. HPV vaccine can effectively prevent cervical cancer. Therefore, the "Global Strategy to Accelerate the Elimination of Cervical Cancer" issued by the World Health Organization advocates that 90% of girls have completed human papilloma before the age of 12. Virus vaccination.

　　"But the injection of HPV vaccine does not mean everything will be fine." Shen Yuanming emphasized, "The common 14 high-risk HPV viruses can cause about 90% of cervical cancers, but the current vaccines cannot fully cover all high-risk HPV virus types, so Cervical cancer screening is also essential after HPV vaccination."

　　Some time ago, Shen Yuanming treated a patient who was unfortunately still recruited after being injected with the HPV vaccine.

35-year-old Ms. Li (pseudonym) usually pays attention to physical maintenance. As early as 8 years ago, she went to Hong Kong to get the HPV vaccine, thinking that she could completely stay away from cervical cancer.

　　Last year, she was diagnosed with uterine fibroids after giving birth to her second child, and has been following up regularly.

During a B-ultrasound examination, the local hospital doctor found that her uterine mucosal cavity was enlarged and the blood supply was abundant. She was highly suspected of cervical cancer. Later, she was transferred to the Zhejiang University Women's Hospital for cervical canal biopsy, which was finally diagnosed as cervical cancer.

　　Most women experience infection

　　Positive patients do not have to worry too much about cancer

　　Shen Yuanming said that HPV vaccination and cervical cancer screening are two indispensable links in the prevention of cervical cancer.

For young girls, vaccination makes more sense; for adult women, both vaccination and regular screening are important, and if HPV and cervical cytology are double negative, physical examinations can be performed every 3 years.

In addition, for patients with abnormal vaginal discharge, sexual intercourse bleeding and other symptoms, even if the screening is double negative, they should go to a regular hospital for gynecological examination to avoid missing the rare non-HPV-related cervical cancer.

　　But once the HPV virus is found to be positive, there is no need to worry too much.

Although high-risk HPV infection is a clear cause of cervical cancer, more than 70% to 80% of women have at least one HPV infection in their lifetime, but most of them are "transient", and only 1% to 4% of the population develop persistent infection. And then develop into cervical cancer.

　　"Some HPV-positive patients are too worried about cancer and have frequent re-examinations. In fact, this not only aggravates their anxiety, but also causes a waste of medical resources."

　　She said that for non-HPV16 and HPV18 subtype positive patients, if TCT (liquid-based thin-layer cell test) is negative, re-examination in 6-12 months is enough; if any high-risk subtype of HPV is positive and TCT positive, it is necessary to Further colposcopy was performed to confirm the presence or absence of precancerous lesions.

　　Pregnant women should also be screened for cervical cancer

　　Cervical cancer in pregnancy is uncommon

　　"Pregnant women should also undergo routine cervical cancer screening during pregnancy." Li Baohua, chief physician of the Obstetrics Department of Zhejiang University Gynecology Hospital, emphasized, "The domestic awareness of this aspect needs to be improved. For example, the number of cervical cancer screenings during pregnancy in Zhejiang Province is still less than the total number of pregnant women. 1%."

　　Diagnosis and treatment guidelines at home and abroad unanimously recommend that women who have not undergone cervical cancer screening within one year of pregnancy should be screened during pregnancy or postpartum.

The time of the first screening is suggested to be more appropriate from 12 to 26 weeks of gestation. After 20 weeks of gestation, the stability of the uterus increases, and safety is more recommended.

If you miss cervical cancer screening during pregnancy, 42 days postpartum is still a good time.

　　Every year, Zhejiang University Women's Hospital will receive about 10 patients with pregnancy complicated with cervical cancer.

Recently, a breastfeeding mother, Xiao Zhou (pseudonym), came to the doctor because of vaginal bleeding. The examination found a 5 cm-large mass in the cervix, and was finally diagnosed with cervical cancer, and also had retroperitoneal lymph node metastasis.

　　During the doctor's consultation, she found that she had not undergone cervical cancer screening during pregnancy and postpartum, and because of the cesarean section, no abnormality was found during the delivery.

　　"Can colposcopy also be done during pregnancy, will it not affect the fetus?" At the same time of regret, Xiao Zhou also expressed doubts.

　　Li Baohua said that a large number of clinical data show that cervical cancer screening during pregnancy is very safe and will not cause serious complications such as premature birth, miscarriage or infection. In a few cases, there will be a small amount of vaginal bleeding, but the amount of bleeding is small. After compression to stop the bleeding, the bleeding will stop, so cervical cancer screening during pregnancy is safe and reliable.

　　The Women's Hospital of Zhejiang University has also set up a "Cervical Disease Screening Clinic during Pregnancy" to provide targeted examinations and treatments for pregnant women who are planning to conceive and who are already pregnant.