Double Ribbons campaign:How to reduce the incidence of breast cancerand cervical cancer in Chinese women

Wen-Ming Cao ,Xiao-Ying Meng ,Xiu-Rong Wang ,Qing-Hua Ma ,Bao-Jun Pan*

1Changle County People's Hospital,Shandong Province,China.

Abstract The Double Ribbons campaign is a combination of the pink ribbon and the blue ribbon.China has launched the "Double Ribbon Campaign," which includes free screening for both breast and cervical cancers.In this paper,by briefly describing the characteristics of breast cancer and cervical cancer,this paper summarizes the screening data of Changle County People's Hospital in Shandong Province in the past ten years,clarifies the importance of early screening,early diagnosis and early treatment of diseases,summarizes experience,defines goals,and promotes the long-term development of China's health cause.

Keywords:Double ribbon campaign;breast cancer;cervical cancer

Introduction

The Double Ribbons campaign is a combination of the Pink Ribbon and the Blue Ribbon.Breast cancer screening is indicated by the pink ribbon,and cervical cancer screening is indicated by the blue ribbon.The "Double Ribbons Campaign" is a large-scale public awareness campaign focused on women's breast and cervical health.

The "Double Ribbons Campaign" also became the "two cancer"screening.Refers to people as the foundation for developing breast cancer and cervical cancer,and the area under its jurisdiction of census register 35-to 64-year-old rural women to carry on the propaganda and mobilization,through some clinical common,economic,and effective inspection method,for health population census,the purpose is to identify precancerous lesions and early treatment,in order to reduce the morbidity and mortality of the two types of cancer,and improve women's health [1].The "two cancers"screening program is one of the major public health programs in China.Public health programs have the characteristics of public welfare and are generally implemented by the government and targeted at the health problems of the people [2].

The women's health index is a barometer for assessing the national population's health and quality of life,and it is an important part of constructing a healthy China.Breast cancer and cervical cancer are the two most common malignant tumors in women,and both pose a serious threat to their health.China has launched the "Double Ribbon Campaign," which includes free screening for both breast and cervical cancers,to help women improve their self-care awareness,increase their knowledge of disease prevention,cultivate a healthy,civilized,and scientific way of life,and reduce the morbidity and mortality of both cancers.Globally,more than 2 million women are diagnosed with breast or cervical cancer each year [3].

Breast cancer is one of the most common malignant tumors in women and is a serious threat to women's physical and mental health.It is considered a global public health problem [4].Cervical cancer is the second leading cause of cancer-related mortality among women in China.The aim of the Double Ribbons campaign is to reduce the morbidity and mortality of these two types of cancer and improve the health quality of women through the screening of healthy people through the promotion and mobilization of women and through some clinically common and cost-effective screening methods to identify precancerous lesions and conduct early treatment.Breast cancer and cervical cancer were eliminated as early as possible.Early diagnosis,early detection,early prevention,early treatment.

Conceptual Framework

The "Healthy China 2030" strategic plan targets "to increase overall five-year cancer survival rates by another 15 percent by 2030.Breast cancer is the most common malignant tumor and seriously threatens the health of women worldwide.Breast cancer was also the most common cancer and the fifth leading cause of cancer deaths among women in China in 2015 [5].Among the most common cancers in women,cervical cancer is one of the leading causes of cancer-related deaths,ranking fourth in frequency and mortality worldwide and second behind breast cancer in developing countries,with approximately 604,000 global new cases and 342,000 deaths in 2020[6].Compared with the GLOBOCAN 2018 data,the incidence and mortality of cervical cancer in China (ASIRW and ASMRW:10.7/100,000 and 4.4/100,000,respectively) were lower than those in the world (13.1/100,000 and 6.9/100,000,respectively).This finding indicated that the incidence and mortality of cervical cancer in China were still at slightly high levels worldwide,although the incidence and mortality in China ranked 119th and 123th among 185 countries or territories of the world in 2018,respectively [7].

About Breast Cancer

Description

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer deaths among women worldwide [8].Among women,breast cancer accounted for approximately 24.5% of all cancer cases and 15.5% of cancer deaths,ranking first for incidence and mortality in the majority of the world countries in 2020 [9].The burden of breast cancer may continue to rise in the future due to rapid economic development,population aging and expansion,and the rising prevalence of key risk factors [10,11].There were approximately 2.3 million new breast cancer cases and 685,000 breast cancer deaths worldwide in 2020 [12].

Gender Distribution

Despite the fact that men can get breast cancer,the American Cancer Society estimates that women are affected 100 times more than men.When compared to women,men are predicted to have a breast cancer incidence of 0.5-1 percent.Male breast cancer (MBC) is becoming more common,although its fatality rate has remained constant,unlike female breast cancer (FBC).This stagnation is mostly due to a lack of significant breakthroughs in the understanding and treatment of the condition.

Despite the fact that the frequency of MBC is increasing,mortality from MBC has remained stable,unlike FBC.Historically,treatment has been based on FBC procedures.The potential prognostic variables of MBC,including as HER2 overexpression and angiogenesis indicators,need to be studied further.MBC differs from FBC in terms of epidemiology,genetics,pathophysiology,tumor features,hormonal implications,and prognostic variables;these differences must be taken into account if significant progress in treating this difficult disease is to be made.Hormonal therapy remains the mainstay of treatment for MBC,but more research is needed to evaluate the role of hormonal manipulation,particularly that of aromatase inhibitors [13].

Age Distribution

As an individual gets older,the chances of abnormal cellular changes in their body increase.Breast cancer cases are elevated in younger women in minority cohorts in the United States.Much of this is due to their younger age distributions,particularly for Hispanic women,but beyond this,there are elevated risks in younger Black and Asian women.Disparities increase further for minority women when being diagnosed with more advanced disease or dying of breast cancer before the age of 50 years is considered [14].

The National Cancer Institute (NCI) found that physicians most frequently diagnose breast cancer in women aged 55 to 64 years,with a median age of diagnosis of 62 years old,as reported in the Medical News Today.Taking data from 2012 to 2016,the NCI reported that out of the 437,772 women diagnosed with breast cancer,approximately 8,300 (1.9%) were in the 20-34 age group,36,700(8.4%) were in the 35-44 age group,87,900 (20.1%) were in the 44-55 age group,112,000 (25.6%) were in the 55-64 age group,108,500 (24.8%) were in the 65-74 age group,59,900 (13.7%) were in the 75-84 age group,and 24,500 (5.6%) were in the 84 and above age group.In recent years,the incidence of breast cancer has been trending younger,which is a serious threat to women's health and life safety[15,16].At present,the incidence rate of breast cancer in China has been higher than the world average and is increasing year by year[17].After dividing the data of the GLOBOCAN 2020 Chinese female population by age,the age-standardized incidence and mortality of breast cancer in Chinese women ranked first in all cancer species among women aged 30 to 54 years.As with global trends,morbidity and mortality also increase with age.The age standard incidence was highest among women aged 60 to 64 years (124.9/10 million),and the age standard mortality was highest among women aged 70 years and older [18].

Signs and Symptoms of Breast Cancer

Breast thickening or a painless lump are the most prevalent early signs and symptoms of breast cancer.A change in the size,appearance,or shape of the breast;changes in the breast skin,such as redness,pitting,or dimpling;a change in the appearance of the areola,the skin that surrounds the nipple;and discharge from the nipple that is unusual or out of the ordinary are all signs to keep an eye on.

The following are important breast cancer symptoms:a painless bump in the breast,under the collarbone,or beneath the arm (some lumps are benign,while others are malignant);breast pain that does not go away after the next period;skin of the breast,nipple,or areola suddenly becoming tender,itchy,scaly,sore,or red;sudden asymmetry of breasts,such as sudden swelling of a breast or sudden shrinking of a breast;and nipple discharge from one of the breasts that can be clear or bloody.

Complications of Breast Cancer

If the "in situ" malignant cell growth is not detected and treated early,it may continue to grow and permeate into the surrounding tissue,resulting in "invasive breast cancer," as well as pervading the nearest lymph nodes,resulting in "regional metastasis," and eventually progressing to other bodily organs,resulting in "distant metastasis."

Despite being generally safe,breast cancer surgery can result in a variety of problems.Due to possible physical changes arising from rigorous treatments,psychological consequences include worry,anxiety,lack of sleep,loss of sexual interest,and depression.Inflammation of the lungs,heart problems,and subsequent malignancies are all possible side effects.Hematoma,or a collection of blood under your skin,seroma,or a collection of fluid on the surgical site,lymphedema,or swelling of the arm on the operation side,and anesthetic reactions are all possible risks.Chemotherapy is used to treat breast cancer at various stages.It may give rise to complications,such as low immunity 7-14 days after undergoing chemotherapy and thus prone to infections,hair loss and thinning due to chemotherapy,nausea and vomiting episodes after chemotherapy,constipation or diarrhoea,dental and mouth problems,such as sore gums,mouth ulcers,dry skin and brittle nails,constant exhaustion,infertility,early menopause and menopausal symptoms (hot flashes and vaginal symptoms).

Risk factors

Breast cancer is a multifactorial disease,and both genetic and environmental factors can affect its disease burden.Based on domestic and foreign studies,the current risk factors for breast cancer are mainly reported as follows.

(1) Age:Age is an important risk factor for breast cancer,and the incidence of breast cancer increases [19] with age.GLOBOCAN The 2020 data similarly confirm this trend in [20].The average age of confirmed breast cancer among Chinese women is 45–55 years.

(2) Reproductive and hormonal:Reproductive and hormonal factors mainly include early age at menarche,late age at first birth,no births or low births,oral contraceptives,late menopause and menopausal hormone therapy,and no breastfeeding [21].Meanwhile,induced abortion,use of hormone and ovulation drugs and term production are also associated with the risk of breast cancer.Endogenous estrogen in premenopausal women is usually produced by the ovary,and oophorectomy reduces the risk of breast cancer [22].The main sources of exogenous estrogen are oral contraceptives and HRT,with hazard ratios of 1.48 and 1.95 [23] after 4 and 8 years of HRT use,respectively.

(3) Life style:Smoking,excessive alcohol consumption and sedentary sitting all increase the risk of breast cancer,and the relationship between coffee and breast cancer is currently controversial [24].Alcohol consumption raises the blood levels of related hormones such as estrogen and triggers the estrogen receptor pathway.Smoking,especially in the population of early smoking,increases breast cancer risk [25].

(4) Obesity:Many studies have confirmed that obesity is associated with an increased risk of breast cancer in postmenopausal women,with mixed conclusions on cancer risk in premenopausal women.A positive association between an increased constitution index and breast cancer risk was observed in premenopausal Asian women [26].

(5) Genetic factors:A family history of first-degree relatives is one of the important risk factors for breast cancer [27].Nearly 25% of breast cancer cases were associated with a family history.First-degree relatives with diagnosed breast cancer before the age of 40 years or a number of two or more diagnosed relatives further increase the risk of breast cancer [28].Many genes have been found to be involved in breast cancer,mainly including BRCA1,BRCA2,PTEN,and TP53[29].

(6) History of disease:Nonproliferative lesions,proliferative lesions,atypical lesions,and proliferative or atypical lesions are the four categories of benign breast illness that can lead to breast cancer.

(7) Other risk factors:Short lactation,dense breast density,air pollution,late nights,socioeconomic status,diabetes history and radiation may be associated with breast cancer risk [30].

Examination

The doctor will thoroughly examine breasts for any lumps,or any changes in the skin texture,and changes in the nipples.If the symptoms are found to be positive,the doctor will suggest imaging tests to determine what is going on inside the body,such as mammograms,breast ultrasound,biopsies,magnetic resonance imaging and ductograms.

Mammograms,which are X-rays of the breast,help to detect any abnormalities in the breast.Breast ultrasound is often used to check any abnormal mammogram results.An ultrasound reveals whether the breast lump is filled with fluid (cyst) or is a solid lump.Biopsies,wherein tissues are removed from the suspicious area and are examined under a microscope.The tissue was further tested to determine whether it was cancerous.Magnetic resonance imaging(MRI) is a procedure in which large magnets and radio frequencies are used to search for cancer.MRI does not use X-rays,so there is no radiation exposure.This captures multiple images of breast tissue on the inside.A ductogram was used to identify the cause of nipple discharge.

Treatment for breast cancer

Depending on the type and stage of breast cancer,there are several ways to treat it,such as surgery,radiation therapy,chemotherapy,hormone therapy and targeted therapy.Treatments for all patients can be a mix of these different types based on the stage of cancer.

Exercise:Exercising is safe during and after cancer treatment,according to research.It has the ability to strengthen the physical body.Furthermore,the stronger you are before to surgery,the faster you will heal.Before beginning an exercise program,people should speak with their doctor to establish what types of workouts are best for them.If someone has never exercised before,they may require the assistance of a physical therapist.

Screening and Prevention

Primary prevention:Active prevention and interventions should be taken for risk factors and breast cancer.The publicity and education of breast cancer health knowledge and behavior modes should be strengthened,and the awareness rate of core cancer knowledge should be improved.Restricting alcohol and tobacco consumption,promoting the construction of a smoke-free environment and monitoring and improving air pollution are important measures for cancer prevention and control.Healthy lifestyle habits,such as nonsmoking and drinking,strengthening physical exercise,reducing dietary fat intake,female reproductive and hormone-related factors such as first birth age,should not exceed 35,reducing the use of oral contraceptives,and promoting breastfeeding can reduce the risk of breast cancer and death.

Secondary prevention:Breast cancer screening can effectively improve the early breast cancer diagnosis rate,patient survival rate and quality of life.China has formulated breast cancer screening guidelines for the general population and high-risk groups,including stipulating the basis for screening population,measures,requirements,outcome management and follow-up procedures,organizational management requirements,quality control and resource base establishment and management during the process of breast cancer screening.

Screening method and interval:For women at risk,the guidelines recommend breast X-ray every 2 years be directed against women at high risk of breast cancer aged 40-44 years without early-onset familial breast cancer or without pathogenic genetic mutations to recommend annual breast ultrasound screening (annual breast MR imaging is recommended when breast ultrasound screening is negative).For other women at high risk of breast cancer,breast ultrasound screening is recommended annually (when breast X-ray photography and breast ultrasound screening are negative,supplementary breast magnetic resonance imaging is recommended).With the policy support of the Healthy China Action (2019-2030),we should strengthen health knowledge popularization,conduct in-depth research on primary prevention,improve the effect of breast cancer screening,achieve early detection,early diagnosis and early treatment,effectively control the burden of breast cancer diseases,and help achieve the grand goal of a healthy China.

Regarding Cervical Cancer

Etiology and Epidemiology

In 2018,there were approximately 570000 new cases of cervical cancer worldwide,accounting for 3.15% of all malignant tumors and approximately 310,000 deaths,accounting for 3.26% of the total number of malignant tumors.Cervical cancer is the sixth most common malignant tumor in Chinese women.In 2015,111,000 new cervical cancer cases were reported nationwide,accounting for 2.83%of all malignant tumors,and the deaths of cervical cancer were approximately 34,000,accounting for 1.45% of all malignant tumors[31].Cancer of the cervix is still a major problem and burden worldwide.It is estimated that every 2 minutes,one woman dies from cervical cancer [32].

Due to improvements in screening techniques,the mortality rate associated with cervical cancer has fallen by approximately 50%worldwide.Cervical cancer is the leading cause of death among women in Africa,India and China and accounts for close to one-third of the total cases reported globally.Epidemiological studies suggest that human papillomavirus (HPV) is the primary cause of cervical cancer.HPV is also responsible for anal,penile,vaginal,head,and neck cancers.HPV infection is very common,and the risk of infection for women aged 15–80 years is 50–80%.Most HPV infections are inherently cleared by the body.In 10–20% of women,the virus persists and progresses into cervical intraepithelial neoplasm lesions by infecting the basal layer of keratinocytes.The infection metastasizes into an invasive cancer of the cervix upon expression of viral proteins E6 and E7,which deregulate cell differentiation and proliferation [33].Although cervical cancer risk overall is elevated among women living with human immunodeficiency virus (HIV;WLH),it is unclear whether risks are similarly elevated across histologic subtypes [34,35].

Cervical cancer can develop on the ectocervix,which is visible in the vaginal canal,or on the endocervix,which connects the vaginal canal to the uterus.Cervical cancer is divided into two categories,each called by the type of cell that the disease began in.Cervical cancers of other forms are uncommon.Squamous cell carcinoma makes for around 80% to 90% of all cervical malignancies.These malignancies begin in the cells that line the cervix's outer surface.Adenocarcinoma is responsible for 10% to 20% of all cervical malignancies.The glandular cells that border the lower birth canal in the interior section of the cervix are where these tumors begin.The squamocolumnar junction is where squamous and glandular cells meet at the cervix's opening,and here is where most cervical malignancies begin.

Symptoms and Physical Findings

Precancer frequently has no symptoms or indicators.Early-stage cervical cancer usually causes symptoms.The symptoms of advanced cancer or cancer that has spread to other regions of the body may be more severe,depending on which tissues and organs have been affected.A symptom might be caused by something other than cancer,which is why individuals should seek medical help if they develop a new symptom that does not go away.

Any of the following could be signs or symptoms of cervical cancer:blood spots or light bleeding between or following periods;menstrual bleeding that is longer and heavier than usual;bleeding after intercourse,douching,or a pelvic examination;increased vaginal discharge;pain during sexual intercourse;bleeding after menopause;unexplained,persistent pelvic and/or back pain.Any of these symptoms should be reported to the doctor.If these symptoms appear,it is important to talk with the doctor about them even if they appear to be symptoms of other,less serious conditions.The earlier precancerous cells or cancer is found and treated,the better the chance that the cancer can be prevented or cured.

Weight loss occurs late in the disease.With advanced disease,there may be enlarged inguinal or supraclavicular lymph nodes,edema of the legs,ascites,pleural effusion,or hepatomegaly,but these are not commonly seen.The pelvic examination in early cervical cancer may reveal a cervix that appears normal,especially if the lesion is endocervical.Visible disease may take several forms:ulcerative,exophytic,granular,or necrotic.The cervix may be friable and bleed upon palpation.There is often an associated serous,purulent,or bloody discharge.Invasive cancer usually presents with postcoital infertility or postmenopausal vaginal bleeding.Persistent vaginal discharge,pelvic pain,leg swelling,and urinary frequency are usually seen with advanced disease.

Management

If cervical cancer is diagnosed,relieving symptoms remains an important part of cancer care and treatment.This may be called palliative care or supportive care.It is often started soon after diagnosis and continued throughout treatment.

Management of cervical cancer is primarily by surgery or radiation therapy,with chemotherapy a valuable adjunct.Surgery is suitable for early stages,where cervical conization,total simple hysterectomy,or radical hysterectomy may be selected according to the stage of disease and extent of spread of cervical cancer.In LMICs,the majority of patients present with locally advanced disease,where surgery plays a limited role,and radiotherapy has an important role.Over the last two decades,the development of sophisticated planning and delivery techniques and the introduction of computer technology and imaging have galvanized the practice of radiotherapy,resulting in improved clinical outcomes and reduced toxicity.

Risk Factors

Approximately 85%of deaths worldwide from cervical cancer occur in low-and middle-income countries,where the death rate is 18 times higher than that in developed countries.It is known that the cause of cervical cancer is the oncogenic subtype of the HPV (human papilloma virus) virus,especially subtypes 16 and 18 [36].The risk factors for cervical cancer include [37] sexual activity at a young age,having sex with multiple partners,smoking,having many children,low socioeconomic status,use of birth control pills (with negative or positive HPV),sexually transmitted diseases,and immune disorders.HIV is also a risk factor for cervical cancer.

(1) Sexual factors:An individual has a greater risk of being infected with HPV if he has multiple sexual partners or is a partner who has had multiple sexual partners.The use of condoms may not adequately protect individuals from exposure to HPV because the virus can be transmitted by contact with infected tissue that is not protected by condoms [38].All women who are sexually active have a risk of developing cervical cancer or the early stages of the disease regardless of age or lifestyle [39].

(2) Human papillomavirus (HPV) infection:The most important risk factor for cervical cancer is infection with HPV.The majority of individuals become infected with HPV when they begin sexual activity,and the majority of people eliminate the virus without complications.There are more than 100 varieties of HPV,and not all of them are associated to cancer.The most important risk factor for development to high-grade dysplasis and invasive cancer is persistent cervical infection (typically defined as an infection identified more than once in a 6 month or longer interval) with oncogenic HPV strains(particularly HPV-16 and HPV-18).The kind of HPV has an impact on the risk of cancer.The presence of several types of HPV tends to increase with the severity of cervical disease.Several types of HPV,usually with at least one type classified as high risk,were found in 12% of patients with normal cytology and in 35% of patients with mild or moderate dysplasia [38].

(3) Immune system deficiency:People with lower immune systems have a higher risk of developing cervical cancer.Immune suppression from corticosteroid medicines,organ donation,therapies for different forms of cancer,or the human immunodeficiency virus (HIV),which causes acquired immune deficiency syndrome,can all create a weakened immune system (AIDS).When a person has HIV,their immune system is less able to fight off early cancer.

(4) Herpes:Cervical cancer is more likely in women who have had genital herpes.Some researchers believe that sexually transmitted viruses may have a role in the development of cervical cancer.It has been claimed that herpes simplex virus type 2 coinfection may play a role in the onset of cervical cancer.Cytomegalovirus (CMV) and herpesviruses (HHV-6 and HHV-7) have also been detected in the cervix.Coinfection offers an opportunity for the virus to interact with HPV.

(5) Smoking:Women who smoke have a nearly two-fold increased risk of cervical cancer than women who do not smoke.Smoking appears to be a significant independent risk factor for HPV infection and increased incidence of cervical illness.Tobacco contains carcinogens,which can be inhaled through cigarettes or chewed.Nicotine content in cervical sap is 56 times greater than in serum in women who smoke.Nicotine in cigarettes makes it easier for all mucous membranes,including mucous cells,in the uterus to become aroused [39].

(6) Age:Cervical cancer is uncommon in those under the age of 20.Between the ages of late adolescence and mid-thirties,the chance of developing cancer rises.Women past this age group remain at risk and need to have regular cervical cancer screenings,which include a Pap test and/or an HPV test.

(7) Socioeconomic factors:Cervical cancer is more prevalent among women who are less likely to have access to cervical cancer screening.Black women,Hispanic women,American Indian women,and women from low-income homes are more likely to fall into this category.

(8) Oral contraceptives:Some research studies suggest that oral contraceptives,which are birth control pills,may be associated with an increased risk of cervical cancer and may be associated with higher-risk sexual behavior.Women who have used oral contraceptives for 5 years or more have a greater risk of developing cervical cancer than women who have never used oral contraceptives[40].

(9) Exposure to diethylstilbestrol (DES):Women whose mothers were given this medicine to prevent miscarriage during pregnancy had an increased chance of getting a rare kind of cervix or vaginal cancer.From about 1940 until 1970,DES was used for this purpose.Women who have been exposed to DES should undergo a pelvic exam every year,which should include a cervical Pap test as well as a 4-quadrant Pap test,which takes samples of cells from all sides of the vagina to look for abnormal cells.

Women who are overweight or obese are at twice the risk of cervical adenocarcinoma than women of normal weight.Nutrition,healthy and nutritionally balanced food will increase antioxidants,which are useful for preventing the neoplasia process [41].

Prevention

The prevention of cervical cancer lies in early prevention,early detection and early treatment.The order of cervical cancer prevention mode is primary prevention-secondary prevention-tertiary prevention.Low-and middle-income countries carry a high burden of preventable cervical cancer cases and deaths.Cervical cancer is a disease of inequality.The majority of cervical cancer cases can be prevented through vaccination against human papillomavirus (HPV)(primary prevention) and screening and early treatment of precancerous lesions caused by HPV infections (secondary prevention),and it can be controlled if treated in early stages (tertiary prevention) [42].Human papillomavirus DNA-based testing is increasingly becoming the preferred method of screening for cervical cancer prevention [43].Vaccination against HPV before having sex is an effective way to prevent cervical cancer.

Cervical cancer screening mainly includes gynecological examination,vaginal/cervical secretion examination,Pap test of cervical exfoliated cells or acetic acid staining/compound iodine staining.HPV and colposcopy should be performed in patients with positive or suspicious results of cervical exfoliation pap test or cervical acetic acid staining/compound iodine staining.Further histopathological diagnosis is required for suspicious or positive colposcopy results.

HPV classification and vaccines against:

HPV infection is linked to nearly all cervical malignancies,as well as a considerable number of anogenital and oropharyngeal cancers.Human papillomavirus (HPV) is thought to be the cause of approximately 5% of all malignancies in the globe.HPV infection is also associated with other skin and mucosal lesions,such as warts and benign papillomas.The majority of HPV infections do not cause symptoms or disease and are cleared within 12–24 months post-infection.Only a small fraction of those infections that persist or progress to a preneoplastic lesion result in cancer.The natural history of HPV infection and the development of novel strategies for improving the management of HPV-positive lesions and the prevention,early identification,and treatment of HPV-associated malignancies require an understanding of environmental,host,and viral variables.

Human papillomavirus (HPV) vaccinations were first released in 2006,and there are currently three vaccines available for the prevention of HPV infections and HPV-related illnesses.By the end of 2019,the World Health Organization (WHO) reported that over 100 countries had introduced HPV vaccination in their national programs[44].

Infections with HPV strains 16 and 18,which are linked to 70% of cervical malignancies,are prevented by all vaccinations.The bivalent vaccination (2vHPV) gives significant cross-protection against HPV 31,33,and 45,which are not vaccine types.Quadivalent vaccination(4vHPV) also protects against HPV strains 6 and 11,which are responsible for more than 90% of anogenital warts.The most recent vaccination,9vHPV,was released in 2015 and protects against infection with five additional high-risk varieties (HPV 31,33,45,52,58),which are linked to an extra 15% of cervical malignancies.

Double Ribbons Campaign

Our hospital is in accordance with the national policy for breast cancer and cervical cancer screening.In the past 10 years,90,896 women had free breast examination,a total of 57 cases of breast cancer were found,and the incidence of breast cancer in Changle was 0.627‰.During the 10-year period,90,471 women were screened for cervical cancer,and a total of 46 cervical cancers were detected;the incidence of cervical cancer was 0.51‰.It can be seen that two cancer screenings are of great significance and can detect cancer early (Table 1).For breast and cervical cancer identified in screening,they will be further followed in Table 2.Breast and cervical cancer Screening Programs for 2022 are shown in Table 3.

Conclusion

Public health reform is one of the important parts of future national medical reform.Public health programs are directly linked to people's healthy lifestyles,and while the public's health awareness has grown as a result of a succession of programs,the notion of self-health management has yet to be completely created.In the future,our administration will rely on policy direction and budgetary assistance to ensure that fundamental public health services are steadily equalized and diversified [45].

In PDCA cycle theory through Plan,Do,Check,and Action,analyze the current situation,identify the problem,identify the cause of the problem,identify the main cause,develop an improvement plan,implement the improvement plan,check the implementation effect,standardize and consolidate the achievement,and incorporate the remaining problems into the next cycle,completing the whole process of optimizing the project management of"two cancers"screening.

(1) People's hearts are profoundly embedded in the notion of"screening the masses as the center," and their consciousness of serving the public is enhanced.The old "function"-centered paradigm was broken throughout the process optimization process,and the process was built based on the idea of public convenience rather than management convenience.

(2) Developing a novel procedure for managing "two cancers"screening.The new procedure has increased the public's excitement and happiness in participating in the screening,as well as their perception of access.

The following are some of the research's future directions:1)Studying how to raise public health awareness,as well as how to expand resources,develop methods,build a public opinion milieu that cares about women and health in general,and enhance screening coverage rates.(2) To create assessment indices for the "two cancers"screening process management.Previously,the project's assessment indicators were mostly medical-related,such as screening coverage rate,early diagnosis rate,and abnormal/suspicious case follow-up management rate.

In the future,we should look at adding social effect assessment indices such as knowledge of prevention and treatment,as well as service receiver satisfaction,to evaluate the project's execution and output in a more comprehensive and scientific approach.