Selecting Screening Methods to Eliminate Cervical Cancer (Cytology alone, HPV primary testing, Cytology/HPV co-testing, Self-collected HPV test)

<p> In Japan, the prevalence of precancerous lesions continues to increase to 2% and the prevalence of cancer continues to increase to 15 due to the sluggish cervical cancer screening rate of 43% and HPV vaccination rate of 1%. We must aim to eliminate cervical cancer only by screening. For that purpose, it is necessary to select a screening method that raises the consultation rate of 25-45 years old, who has the most precancerous lesions, to 80% or more, and does not overlook the precancerous lesions. 1) Cytopathology single examination; Precancerous lesion detection sensitivity in Japan is 85%, specificity 95%. Since the prevalence of precancerous lesions in Japan is 2%, the estimated number of missed cases is 300 out of 100,000. If the consultation rate of 80% can be maintained, the morbidity rate can be reduced to 10. 2) HPV primary testing; detection sensitivity is 95%, specificity is 91%. The number of missed items is estimated to be 100. Morbidity can be reduced to 8. 3) Cytopathology/HPV co-testing; detection sensitivity is 99%, specificity is 90%. The number of missed items is estimated to be 20. Morbidity can be reduced to 5. In Izumo City, which has 12 years of HPV combined examination results, the youth consultation rate was 75% and the morbidity rate decreased to 5. 4) Self-collected HPV test; The concordance rate with the doctor-collected HPV test was 85% for both positive match rate and negative match rate. By mail, 30% of unexamined patients underwent this test, and 10.8% of precancerous lesions could be detected. In Japan, cytopathology/HPV co-testing screening should be selected until the prevalence of precancerous lesions decreases to 0.4 and the morbidity to 7. The mail-type self-collection HPV test is very effective as a measure for young people who have not been examined.</p>