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Yang H, Aydi W, Innab N, Ghoneim ME, Ferrara M. Classification of cervical cancer using Dense CapsNet with Seg-UNet and denoising autoencoders. Sci Rep 2024; 14:31764. [PMID: 39738568 PMCID: PMC11686288 DOI: 10.1038/s41598-024-82489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Accepted: 12/04/2024] [Indexed: 01/02/2025] Open
Abstract
Cervical cancer is one of the deadly diseases that affects women, which requires periodic examinations to identify and treat any cancerous tumors at a preliminary stage. The most prevalent examination tool for cervical cancer prompt identification is the cervical smear (Pap smear) testing; however, due to human negligence, this examination method has an elevated probability of negative findings. Cervical cancer classification using machine learning (ML) and deep learning (DL) has been extensively studied to enhance the conventional diagnostic process. Robust classification results were achieved through the pre-segmented imagery in most current investigations. Conversely, cellular grouping makes reliable cervical cellular segmentation difficult. Additionally, the deep learning methods used in the existing works perform poorly on a multiclass classification when the data distribution is skewed, which is common in the cervical cancer dataset. To mitigate these restrictions in cervical cancer research, this proposed work uses a combination of four different deep-learning methods in various phases of this research. The proposed work is segregated into five phases: pre-processing, data augmentation, segmentation, feature extraction, and classification. Contrast maximization is performed in the pre-processing phase, and the images are augmented using Multi-modal Generative Adversarial Networks (m-GAN) in the second phase. In the third phase, cervical cancer images are segmented using the Seg-UNet model, which is forwarded to the feature extraction phase that employs denoising autoencoders. Finally, the classification is implemented using the Dense CapsNet model and applied to the SIPaKMeD dataset to categorize between normal, abnormal, and benign classes. The proposed system achieves an accuracy of 99.65%, which is higher than the other works in the literature.
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Affiliation(s)
- Hui Yang
- Department of Critical Medicine, Baoshan People's Hospital, Baoshan, 678000, Yunnan Province, China.
| | - Walid Aydi
- Department of Computer Science, College of Computer Engineering and Sciences, Prince Sattam Bin Abdulaziz University, 11942, Al-Kharj, Saudi Arabia
- Laboratory of Electronics & Information Technologies, Sfax University, Sfax, Tunisia
| | - Nisreen Innab
- Department of Computer Science and Information Systems, College of Applied Sciences, AlMaarefa University, Diriyah, 13713, Riyadh, Saudi Arabia
| | - Mohamed E Ghoneim
- Faculty of Computers and Artificial Intelligence, Damietta University, Damietta, Egypt
- Mathematics Department, Faculty of Sciences, Umm Al-Qura University, Mecca, Kingdom of Saudi Arabia
| | - Massimiliano Ferrara
- Decisions LAB, Department of Law, Economics and Human Sciences, University Mediterranea of Reggio Calabria, Via dei Bianchi, 2, 89131, Reggio Calabria, Italy.
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Shanmugam A, KVN K, Radhabai PR, Natarajan S, Imoize AL, Ojo S, Nathaniel TI. HO-SsNF: heap optimizer-based self-systematized neural fuzzy approach for cervical cancer classification using pap smear images. Front Oncol 2024; 14:1264611. [PMID: 38751808 PMCID: PMC11094217 DOI: 10.3389/fonc.2024.1264611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/11/2024] [Indexed: 05/18/2024] Open
Abstract
Cervical cancer is a significant concern for women, necessitating early detection and precise treatment. Conventional cytological methods often fall short in early diagnosis. The proposed innovative Heap Optimizer-based Self-Systematized Neural Fuzzy (HO-SsNF) method offers a viable solution. It utilizes HO-based segmentation, extracting features via Gray-Level Co-Occurrence Matrix (GLCM) and Local Binary Pattern (LBP). The proposed SsNF-based classifier achieves an impressive 99.6% accuracy in classifying cervical cancer cells, using the Herlev Pap Smear database. Comparative analyses underscore its superiority, establishing it as a valuable tool for precise cervical cancer detection. This algorithm has been seamlessly integrated into cervical cancer diagnosis centers, accessible through smartphone applications, with minimal resource demands. The resulting insights provide a foundation for advancing cancer prevention methods.
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Affiliation(s)
- Ashok Shanmugam
- Department of Electronics and Communication Engineering, Vel Tech Multi Tech Dr. Rangarajan Dr. Sakunthala Engineering College, Chennai, Tamil Nadu, India
| | - Kavitha KVN
- Department of Communication Engineering, School of Electronics Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Prianka Ramachandran Radhabai
- Department of Artificial Intelligence and Machine Learning (AIML) New Horizon College of Engineering, Chennai, Tamil Nadu, India
| | - Senthilnathan Natarajan
- Department of Design and Automation, School of Mechanical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Agbotiname Lucky Imoize
- Department of Electrical and Electronics Engineering, Faculty of Engineering, University of Lagos, Akoka, Lagos, Nigeria
| | - Stephen Ojo
- Department of Electrical and Computer Engineering, College of Engineering, Anderson University, Anderson, IN, United States
| | - Thomas I. Nathaniel
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
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Jin E, Noble JA, Gomes M. A Review of Computer-Aided Diagnostic Algorithms for Cervical Neoplasia and an Assessment of Their Applicability to Female Genital Schistosomiasis. MAYO CLINIC PROCEEDINGS. DIGITAL HEALTH 2023; 1:247-257. [PMID: 40206624 PMCID: PMC11975695 DOI: 10.1016/j.mcpdig.2023.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/11/2025]
Abstract
Female genital schistosomiasis (FGS) affects an estimated 56 million women and girls in Africa. Nevertheless, this neglected tropical disease remains largely understudied and underdiagnosed. In this literature review, we examine the effectiveness of published computer-aided diagnostic (CAD) algorithms for cervical cancer that use colposcopy images and assess their applicability to the design of an automated image diagnostic algorithm for FGS. We searched 2 databases (Embase and MEDLINE) from database inception to June 10, 2022. We identified 393 studies, of which 13 were relevant for FGS diagnosis. These 13 studies were analyzed for their key image analysis model components and compared with the features that would be beneficial in an FGS diagnostic image analysis system.
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Affiliation(s)
- Emily Jin
- Department of Computer Science, University of Oxford, United Kingdom
| | - J. Alison Noble
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom
| | - Mireille Gomes
- Global Health Institute of Merck, Ares Trading S.A., an affiliate of Merck KGaA, Darmstadt, Germany
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Radiomics Diagnostic Tool Based on Deep Learning for Colposcopy Image Classification. Diagnostics (Basel) 2022; 12:diagnostics12071694. [PMID: 35885598 PMCID: PMC9324247 DOI: 10.3390/diagnostics12071694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Colposcopy imaging is widely used to diagnose, treat and follow-up on premalignant and malignant lesions in the vulva, vagina, and cervix. Thus, deep learning algorithms are being used widely in cervical cancer diagnosis tools. In this study, we developed and preliminarily validated a model based on the Unet network plus SVM to classify cervical lesions on colposcopy images. Methodology: Two sets of images were used: the Intel & Mobile ODT Cervical Cancer Screening public dataset, and a private dataset from a public hospital in Ecuador during a routine colposcopy, after the application of acetic acid and lugol. For the latter, the corresponding clinical information was collected, specifically cytology on the PAP smear and the screening of human papillomavirus testing, prior to colposcopy. The lesions of the cervix or regions of interest were segmented and classified by the Unet and the SVM model, respectively. Results: The CAD system was evaluated for the ability to predict the risk of cervical cancer. The lesion segmentation metric results indicate a DICE of 50%, a precision of 65%, and an accuracy of 80%. The classification results’ sensitivity, specificity, and accuracy were 70%, 48.8%, and 58%, respectively. Randomly, 20 images were selected and sent to 13 expert colposcopists for a statistical comparison between visual evaluation experts and the CAD tool (p-value of 0.597). Conclusion: The CAD system needs to improve but could be acceptable in an environment where women have limited access to clinicians for the diagnosis, follow-up, and treatment of cervical cancer; better performance is possible through the exploration of other deep learning methods with larger datasets.
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Suphalakshmi A, Ahilan A, Jeyam A, Subramanian M. Cervical cancer classification using efficient net and fuzzy extreme learning machine. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2022. [DOI: 10.3233/jifs-220296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cervical cancer is the most common and deadly malignancy affecting women worldwide. The prediction and treatment of this malignancy are necessary in order to avoid serious complications. In recent days, deep learning has enhanced the accuracy of cervical cancer prediction in its early stages. In this study, a deep learning based EN-FELM approach is proposed to detect and classify the cervical cells. Initially, the pap smear images are pre-processed to eliminate the background distortions. The EfficientNet is a reversed bottleneck MBConv used for feature extraction. Consequently, fuzzy extreme learning machine (FELM) is used to classify the healthy, benign, low squamous intraepithelial lesions (LSIL) and high squamous intraepithelial lesions (HSIL). The proposed model acquires the best classification accuracy on Herlev and SIPaKMeD datasets range of 99.6% and 98.5% respectively. As a result, the classification using FELM produces more efficient and accurate result which is significantly high compared to the traditional classifiers. The proposed EN-FELM improves the overall accuracy of 0.2%, 0.13% and 14.6% better than Autoencoder, LSTM and KNN with CNN respectively.
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Affiliation(s)
- A. Suphalakshmi
- Department of AI&DS, Sri Shanmugha College of Engineering and Technology, Sankagiri, Salem
| | - A. Ahilan
- Department of ECE, PSN College of Engineering and Technology, Tirunelveli, India
| | - A. Jeyam
- Nuclear Power Corporation of India Limited, Kudankulam, PO, Radhapuram, India
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Abstract
As an air pollution phenomenon, haze has become one of the focuses of social discussion. Research into the causes and concentration prediction of haze is significant, forming the basis of haze prevention. The inversion of Aerosol Optical Depth (AOD) based on remote sensing satellite imagery can provide a reference for the concentration of major pollutants in a haze, such as PM2.5 concentration and PM10 concentration. This paper used satellite imagery to study haze problems and chose PM2.5, one of the primary haze pollutants, as the research object. First, we used conventional methods to perform the inversion of AOD on remote sensing images, verifying the correlation between AOD and PM2.5. Subsequently, to simplify the parameter complexity of the traditional inversion method, we proposed using the convolutional neural network instead of the traditional inversion method and constructing a haze level prediction model. Compared with traditional aerosol depth inversion, we found that convolutional neural networks can provide a higher correlation between PM2.5 concentration and satellite imagery through a more simplified satellite image processing process. Thus, it offers the possibility of researching and managing haze problems based on neural networks.
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Ali MM, Ahmed K, Bui FM, Paul BK, Ibrahim SM, Quinn JMW, Moni MA. Machine learning-based statistical analysis for early stage detection of cervical cancer. Comput Biol Med 2021; 139:104985. [PMID: 34735942 DOI: 10.1016/j.compbiomed.2021.104985] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/24/2021] [Accepted: 10/24/2021] [Indexed: 12/24/2022]
Abstract
Cervical cancer (CC) is the most common type of cancer in women and remains a significant cause of mortality, particularly in less developed countries, although it can be effectively treated if detected at an early stage. This study aimed to find efficient machine-learning-based classifying models to detect early stage CC using clinical data. We obtained a Kaggle data repository CC dataset which contained four classes of attributes including biopsy, cytology, Hinselmann, and Schiller. This dataset was split into four categories based on these class attributes. Three feature transformation methods, including log, sine function, and Z-score were applied to these datasets. Several supervised machine learning algorithms were assessed for their performance in classification. A Random Tree (RT) algorithm provided the best classification accuracy for the biopsy (98.33%) and cytology (98.65%) data, whereas Random Forest (RF) and Instance-Based K-nearest neighbor (IBk) provided the best performance for Hinselmann (99.16%), and Schiller (98.58%) respectively. Among the feature transformation methods, logarithmic gave the best performance for biopsy datasets whereas sine function was superior for cytology. Both logarithmic and sine functions performed the best for the Hinselmann dataset, while Z-score was best for the Schiller dataset. Various Feature Selection Techniques (FST) methods were applied to the transformed datasets to identify and prioritize important risk factors. The outcomes of this study indicate that appropriate system design and tuning, machine learning methods and classification are able to detect CC accurately and efficiently in its early stages using clinical data.
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Affiliation(s)
- Md Mamun Ali
- Department of Software Engineering (SWE), Daffodil International University (DIU), Sukrabad, Dhaka, 1207, Bangladesh
| | - Kawsar Ahmed
- Department of Electrical and Computer Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada; Group of Biophotomatiχ, Department of Information and Communication Technology, Mawlana Bhashani Science and Technology University, Santosh, Tangail, 1902, Bangladesh.
| | - Francis M Bui
- Department of Electrical and Computer Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada
| | - Bikash Kumar Paul
- Department of Software Engineering (SWE), Daffodil International University (DIU), Sukrabad, Dhaka, 1207, Bangladesh; Group of Biophotomatiχ, Department of Information and Communication Technology, Mawlana Bhashani Science and Technology University, Santosh, Tangail, 1902, Bangladesh
| | - Sobhy M Ibrahim
- Department of Biochemistry, College of Science, King Saud University, P.O. Box: 2455, Riyadh, 11451, Saudi Arabia
| | - Julian M W Quinn
- Bone Biology Division, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Mohammad Ali Moni
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.
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Deepa K, Thilagamani S. A Spatial-Frequency Feature Ensemble for Detecting Cervical Dysplasia from Pap Smear Images. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Among women, cervical cancer is the commonest and the most treatable and preventable type of cancer. In most cases, cervical cancer begins as precancerous changes which gradually develop into cancer. Pap smear is widely used for cervical cancer diagnosis. Cell analysis is a time-consuming
and cumbersome job; thus, an automatic detecting framework is proposed. Wavelet transforms offer the associated coefficients as the input image data representation, used as feature vectors. Artificial Neural Networks (ANNs) have outstanding attributes such as enhanced input-to-output mapping,
non-linearity, fault tolerance, adaptively, and self-learning. Classification of cervical cancers employs neural network systems that have a huge role in most applications related to image processing. For application in diverse fields such as bioinformatics and pattern recognition, most researchers
choose ensemble classifiers. A spatial-frequency feature ensemble has been proposed in this work to identify cervical dysplasia from images of Pap smears.
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Affiliation(s)
- K. Deepa
- Department of Computer Science & Engineering, M. Kumarasamy College of Engineering, Karur 639113, India
| | - S. Thilagamani
- Department of Computer Science & Engineering, M. Kumarasamy College of Engineering, Karur 639113, India
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Lei YM, Yin M, Yu MH, Yu J, Zeng SE, Lv WZ, Li J, Ye HR, Cui XW, Dietrich CF. Artificial Intelligence in Medical Imaging of the Breast. Front Oncol 2021; 11:600557. [PMID: 34367938 PMCID: PMC8339920 DOI: 10.3389/fonc.2021.600557] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 07/07/2021] [Indexed: 12/24/2022] Open
Abstract
Artificial intelligence (AI) has invaded our daily lives, and in the last decade, there have been very promising applications of AI in the field of medicine, including medical imaging, in vitro diagnosis, intelligent rehabilitation, and prognosis. Breast cancer is one of the common malignant tumors in women and seriously threatens women's physical and mental health. Early screening for breast cancer via mammography, ultrasound and magnetic resonance imaging (MRI) can significantly improve the prognosis of patients. AI has shown excellent performance in image recognition tasks and has been widely studied in breast cancer screening. This paper introduces the background of AI and its application in breast medical imaging (mammography, ultrasound and MRI), such as in the identification, segmentation and classification of lesions; breast density assessment; and breast cancer risk assessment. In addition, we also discuss the challenges and future perspectives of the application of AI in medical imaging of the breast.
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Affiliation(s)
- Yu-Meng Lei
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Academic Teaching Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Miao Yin
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Academic Teaching Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Mei-Hui Yu
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Academic Teaching Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Jing Yu
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Academic Teaching Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Shu-E Zeng
- Department of Medical Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Zhi Lv
- Department of Artificial Intelligence, Julei Technology, Wuhan, China
| | - Jun Li
- Department of Medical Ultrasound, The First Affiliated Hospital of Medical College, Shihezi University, Xinjiang, China
| | - Hua-Rong Ye
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Academic Teaching Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Bern, Switzerland
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Zhou J, Zeng ZY, Li L. Progress of Artificial Intelligence in Gynecological Malignant Tumors. Cancer Manag Res 2020; 12:12823-12840. [PMID: 33364831 PMCID: PMC7751777 DOI: 10.2147/cmar.s279990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022] Open
Abstract
Artificial intelligence (AI) is a sort of new technical science which can simulate, extend and expand human intelligence by developing theories, methods and application systems. In the last five years, the application of AI in medical research has become a hot topic in modern science and technology. Gynecological malignant tumors involves a wide range of knowledge, and AI can play an important part in these aspects, such as medical image recognition, auxiliary diagnosis, drug research and development, treatment scheme formulation and other fields. The purpose of this paper is to describe the progress of AI in gynecological malignant tumors and discuss some problems in its application. It is believed that AI improves the efficiency of diagnosis, reduces the burden of clinicians, and improves the effect of treatment and prognosis. AI will play an irreplaceable role in the field of gynecological malignant oncology and will promote the development of medicine and further promote the transformation from traditional medicine to precision medicine and preventive medicine. However, there are also some problems in the application of AI in gynecologic malignant tumors. For example, AI, inseparable from human participation, still needs to be more “humanized”, and needs to further protect patients’ privacy and health, improve legal and insurance protection, and further improve according to local ethnic conditions and national conditions. However, it is believed that with the continuous development of AI, especially ensemble classifier, and deep learning will have a profound influence on the future of medical technology, which is a powerful driving force for future medical innovation and reform.
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Affiliation(s)
- Jie Zhou
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning 530021, Guangxi, People's Republic of China.,Department of Gynecology, The Second Affiliated Hospital, University of South China, Hengyang 421001, Hunan, People's Republic of China
| | - Zhi Ying Zeng
- Department of Anesthesiology, The Second Affiliated Hospital, University of South China, Hengyang 421001, Hunan, People's Republic of China
| | - Li Li
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning 530021, Guangxi, People's Republic of China
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A preliminary cervical cancer screening cascade for eight provinces rural Chinese women: a descriptive analysis of cervical cancer screening cases in a 3-stage framework. Chin Med J (Engl) 2020; 132:1773-1779. [PMID: 31335474 PMCID: PMC6759122 DOI: 10.1097/cm9.0000000000000353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Cascade analysis is an effective method to analyze the processing data of an event, such as a provided service or a series of examinations. This study aimed to develop a primary cervical cancer screening cascade in China to promote the quality of the screening process. Methods: We designed a cervical cancer screening cascade in China according to the program flow chart. It had three stages, each with two steps and one result. Data from 117,522 women aged 35 to 64 years in the Rural Cervical Cancer Surveillance Project from January 1, 2014, to December 31, 2014, were collected to analyze the main results of the cascade. The data and proportion are used to describe the follow-up of cervical cancer and pre-cancer detection rate. Results: In 2014, 117,522 (80.94% of all cases reported by the Rural Cervical Cancer Surveillance Project) women aged 35 to 64 years had not received cervical cytology in the previous 3 years. The pre-cancer and cancer detection rates were 256.12/100,000 and 16.16/100,000, respectively. A total of 3031 cases failed to follow-up through the screening process, and 1189, 1555, and 287 cases were lost at cervical cytology, colposcopy, and histopathological screening stages, respectively. The estimated cases of pre-cancer and cancer cases would have been 544 and 34, respectively, and the estimated detection rates of pre-cancer and cancer would have been 462.89/100,000 and 28.93/100,000, respectively. Conclusion: In order to increase the detection rate of cervical cancer, cervical cancer screening staff should focus on increasing the rate of follow-up of those who are positive for cervical cancer screening (ie, those with positive cytology results), especially for the 40 to 44 years age range.
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