研究目的

本研究旨在深入了解中国不同卫生资源水平地区两癌（宫颈癌和乳腺癌）联合筛查模式的实施现状与潜在优化路径，通过分析服务提供方的支持体系、对联合筛查的评价及筛查参与者的意愿，揭示联合筛查模式推广应用的可行性和必要性，并总结适宜经验，为我国两癌筛查政策的优化和创新提供科学依据和实践指导。

材料和方法

1.不同地区两癌联合筛查支持体系现况：在纳入研究的国内15个两癌筛查现场开展调查，向筛查机构的负责人员发放调查问卷，以收集当地的两癌联合筛查资源条件及工作基础的数据，包括筛查方案、筛查服务覆盖范围、筛查的组织管理三个核心维度的信息。

2.筛查工作者对两癌联合筛查模式的评价与优化建议：在纳入现况调查的部分现场开展调查，对筛查机构的管理者、筛查一线医务人员等进行半结构化访谈，总结在各级工作者的角度是否有必要推荐联合筛查模式，分析联合筛查模式的优势所在，以及根据各级工作者在联合筛查的实际工作中遇到的问题总结其对联合筛查模式的优化建议。

3.不同地区妇女参与两癌联合筛查的意愿及其影响因素：从四大地区选择部分机构的妇女开展调查，每个大区至少包含1个机构。采用便利抽样的方法，抽取2024年5月- 12月参与两癌筛查的部分妇女参与本研究。采用现场问卷调查的方式，调查妇女对两癌筛查的认知情况、对联合筛查的参与意愿以及满意度情况。

研究结果

1.不同地区两癌联合筛查支持体系现况：在筛查方案上，部分机构严格遵循国家推荐方案执行，而另一些机构通过调整宫颈癌筛查或乳腺癌筛查的频率以将两项筛查的频率对齐；覆盖范围方面，宫颈癌筛查在筛查服务覆盖的人群范围和提供的服务项目均多于乳腺癌筛查，但差异较小，两癌筛查的服务工作均在有计划的不断推进中；组织管理方面，两癌筛查宣教方式、人群邀请和随访通知形式多样但宫颈癌筛查宣传形式略多于乳腺癌筛查，各地均建立自己的两癌信息系统，虽然大多数无法联通机会性筛查信息，但可以在本地筛查机构之间实现信息共享。总体来看这些地区的筛查现况比较支持联合筛查的工作开展。

2.筛查工作者对两癌联合筛查模式的评价与优化建议：不同层级的工作者从各自的角度均推荐联合筛查模式，认为联合筛查是更具优势的，包括减少妇女筛查的时间和交通成本、提升妇女的服务获得感以及减小机构的人力成本、提高工作效率、促进服务水平提高等，各级单位会尽可能在各方面提供足够的支持以促进联合筛查的实现。但在推广时还存在一些挑战，包括两癌的筛查间隔时间不统一、信息系统不够完善、乳腺超声科医生不足、经费补助难以支撑联合筛查全过程等，各地应注意根据实际情况进行优化调整，例如可采用5年一次的联合筛查并在联合筛查间期增加一次乳腺癌筛查的模式、构建全国联网信息平台并整合机会性筛查数据、合理制定任务量避免过度筛查、通过统一招标采购等方式压低成本或增加专项补贴等。总的来说，从筛查服务提供方的角度，联合筛查是值得推荐的模式。

3.不同地区妇女参与两癌联合筛查的意愿及其影响因素：共收集到问卷981份，其中87.36%的研究对象知晓政府定期为适龄妇女提供免费两癌筛查这一政策，分别有81.75%和90.72%的研究对象知晓筛查方案中推荐的宫颈癌和乳腺癌筛查方法。针对联合筛查模式，80.73%的研究对象倾向于参与联合筛查模式，多因素Logistic回归结果显示“对两癌筛查的知晓情况”为参与联合筛查意愿的独立影响因素。59.53%的妇女能接受自费或部分自费的联合筛查，多因素Logistic回归结果显示“地区”和“对两癌筛查的知晓情况”为参与联合筛查意愿的独立影响因素。针对联合筛查满意度的调查显示大多数研究对象对所参与的联合筛查是满意的。

研究结论

我国当前两癌筛查体系比较支持联合筛查的工作开展，各级筛查工作者均认为联合筛查是值得推荐的模式，对妇女而言联合筛查模式更受大多数妇女的偏好。结合供需双方的调查，联合筛查模式在提高妇女服务获得感、节省时间和交通成本，以及提高筛查机构的工作效率和服务水平等方面均具有重要意义，是对两癌筛查的供需双方均有利的模式，可以对该模式进行推广。但在推广时应注意对当前存在的问题进行优化调整，包括探索在联合筛查间期增加一次乳腺癌筛查的模式以满足两癌筛查的不同间隔时间、进一步完善两癌筛查信息系统等，以确保筛查工作的科学性和可持续性。通过优化和推广联合筛查模式，我国的两癌筛查有望进一步提高癌症早发现、早诊断、早治疗的比例，降低疾病负担，实现促进女性健康的目标。

Objectives

In order to investigate the current implementation status and potential optimization pathways of integrated screening for cervical cancer and breast cancer across regions with varying healthcare resource levels in China, by analyzing support systems from healthcare providers, evaluations of healthcare providers, and screening participants' willingness, this study seeks to reveal the feasibility and necessity of promoting integrated screening Strategy. It also summarizes adaptable experiences to provide scientific evidence and practical guidance for optimizing China's cervical and breast cancers screening policies.

Materials and methods

1. Current status of support systems for integrated screening for cervical and breast cancer across regions: Field investigations and questionnaires were conducted at 15 screening sites to collect data on resource allocation, service coverage, and organizational management, focusing on three dimensions: screening protocols, service coverage, and organizational governance mechanisms.

2. Evaluation and optimization suggestions of integrated screening strategy by screening practitioners: Semi-structured interviews were conducted with policymakers and frontline healthcare workers across selected sites included in the status survey. These interviews aimed to summarize practitioners' perspectives on the necessity of recommending integrated screening for cervical and breast cancers, analyze the advantages of this strategy, and collate optimization recommendations based on challenges encountered during implementation.

3. Willingness and influencing factors of women in different regions to participate in integrated screening for cervical and breast cancers: Women from selected healthcare institutions across four major regions (at least 1 institution per region) were recruited using convenience sampling between May and December 2024. On-site questionnaire surveys were administered to assess their awareness of cervical and breast cancer screening, willingness to participate in integrated screening, and satisfaction levels.

Results

1. Current status of support systems for integrated screening for cervical and breast cancer across regions: In terms of screening protocols, some institutions strictly followed national recommended guidelines, while others adjusted cervical or breast cancer screening frequencies to align the two programs. Regarding service coverage, cervical cancer screening slightly exceeded breast cancer screening in both population reach and service offerings, though differences were minimal, with both programs being progressively advanced as planned. For organizational management, diverse health education methods, population invitation strategies, and follow-up notifications were implemented, though cervical cancer screening received slightly more promotional efforts. All regions established local information systems for dual-cancer screening; while most lacked interoperability with opportunistic screening data, they enabled information sharing among local screening institutions. Overall, current conditions in these regions demonstrate adequate support for implementing integrated screening strategy.

2. Evaluation and optimization suggestions of integrated screening strategy by screening practitioners: Screening practitioners across different hierarchical levels recommend the integrated screening strategy from their respective perspectives, believing it to be a more advantageous strategy. Benefits include reducing women' s time and transportation costs for screenings, enhancing women' s perceived service quality, lowering institutional labor costs, improving work efficiency, and promoting service quality. Units at all levels will strive to provide sufficient support in all aspects to facilitate the implementation of integrated screening. However, challenges remain during promotion, including inconsistent screening intervals for the two cancers, underdeveloped information systems, insufficient breast ultrasound specialists, and funding subsidies inadequate to support the entire integrated screening process. Each region should optimize adjustments based on local conditions. Examples include adopting a 5-year integrated screening cycle with an additional breast cancer screening during the interval, building a nationally networked information platform to integrate opportunistic screening data, rationally formulating task volumes to avoid over-screening, and reducing costs through centralized procurement or increasing targeted subsidies. Overall, from the perspective of screening service providers, the integrated screening strategy is a recommended strategy.

3. Willingness and influencing factors of women in different regions to participate in integrated screening for cervical and breast cancers: A total of 981 valid questionnaires were collected. Among participants, 87.36% were aware of the government-funded free screening policy for eligible women, while 81.75% and 90.72% correctly recognized the recommended methods for cervical and breast cancer screening, respectively. Regarding integrated screening, 80.73% expressed willingness to participate. Multivariate logistic regression analysis identified "awareness of cervical and breast cancer screening" as an independent influencing factor for participation willingness. Additionally, 59.53% of women accepted out-of-pocket or partially self-paid integrated screening, with "region" and "screening awareness" emerging as independent determinants. Satisfaction surveys revealed that the majority of participants were satisfied with the integrated screening services they received.

Conclusions

China's current breast and cervical cancer screening system demonstrates strong support for the implementation of integrated screening strategy. Screening professionals at all levels unanimously endorse this strategy, and from the participants' perspective, integrated screening is preferred by the majority of women. Comprehensive surveys of both healthcare providers and participants indicate that the integrated strategy significantly enhances women's perceived service quality, reduces time and transportation costs, and improves institutional efficiency and service standards. This mutually beneficial strategy warrants widespread promotion. However, during its expansion, existing challenges must be systematically addressed, including exploring supplemental breast cancer screenings during integrated screening intervals to accommodate differing screening frequency requirements and further optimizing the screening information systems. These measures are critical to ensuring the scientific rigor and long-term sustainability of the programs. By refining and promoting the integrated screening strategy, China' s breast and cervical cancer prevention efforts are poised to improve early detection, diagnosis, and treatment rates, reduce disease burdens, and ultimately advance women' s health goals.