1. Ministry of Health issues
order for organized screening

2. Local clinics collect cervical samples
 

3. Central automated screening
laboratory processes samples

1. The Ministry of Health issues an order and provides funds to conduct a screening program. They notify all women in the target age range under their jurisdiction, educate them on the purpose and importance of the screening with the help of women’s organizations, and invite them to local clinics.
2. At the local clinics, women register and have their cervical specimens collected.
3. The specimens are sent to a centralized screening laboratory to be processed, and the laboratory sends back diagnostic reports with follow-up recommendations if applicable.

Hannan is a rural district of the city of Wuhan. Our first cancer screening trial began here in 2001 on the back of an annual pregnancy test program. Our chairman, Dr. Xiaorong Sun, approached the Ministry of Health and asked for permission to provide cervical cancer screening services to women when they checked in for their pregnancy test. She was granted permission and funding, and established the province’s first organized cervical cancer screening program. The first year we only screened 316 women, but that number rapidly grew to thousands per year. The program has continued successfully to this day and provided free screening to 27,903 women (as of 2014) using prototypes of the Landing Cyto System in various stages of development.

Since 2008 there have been zero mortalities related to cervical cancer in Hannan.

Yiling district is in the city of Yichang, the second largest city in Hubei province after Wuhan. From July 2010 to July 2011, we screened 9,261 women using both the traditional Bethesda System (TBS) and the automated Landing Cyto System. The TBS results showed 604 cases (6.52%) that were ASCUS or higher. Using the Landing Cyto System, we detected 1211 positive cases, or 13.08%.

This pilot program ran from June to December of 2011 and was our first larger scale program. A total of 181,640 women from 15 districts in Wuhan were screened and their cases processed at our automated screening laboratory. 11,769 positive cases (6.48%) were detected and referred to biopsy. The results are published in the Chinese language journal Maternal and Child Health Care of China. 2013;28(8):1238-1240.

Given the success of the Wuhan City Pilot Cervical Cancer Screening Program, the Hubei Ministry of Health expanded it the following year to screen 500,000 women a year in 16 counties across the province. Our laboratory in Wuhan received 142,283 of the cases in 2012, of which 12,140 (8.53%) were positive and referred to biopsy. In 2013 this program expanded to 18 counties and we received 155,639 cases, of which 5,311 (3.41%) were positive. In 2014 we received 116,747 cases, of which 4,283 (3.67%) were positive. During these three years we obtained biopsy data for 39-49% of the positive cases we referred, a percentage we are working on increasing to better understand the sensitivity and specificity of our system.

We performed a cost and benefit analysis of the 142,283 cases we screened in 2012:

• Costs (in USD)
  • Laboratory screening costs: 142,283 cases × $6.45/case = $917,725
  • Cost of further tests and early treatment for positive cases: 12,140 cases × $160/case = $1.94 million
  • For the 142,283 women, total cost of screening and early treatment fees for positive cases therefore totals $917,725 + $1.94 million = $2.86 million
• Social and economic benefits of screening
  • Of the 142,283 women, 130,143 tested negative and would not develop advanced cervical cancer in at least 1-2 years (subject to review every 1-2 years).
  • Without screening, approximately one third of the positive cases would have developed into late cervical cancer and incurred late treatment costs: 4,047 cases × $16,100/case = $65.2 million with no guarantee of saved lives
  • It’s clear that the government’s investment of $2.86 million for screening and early treatment of cervical cancer saved thousands of lives and tens of millions of dollars.