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Objective To implement and evaluate a large-scale online cervical cancer screening programme in Hubei Province, China, supported by artificial intelligence and delivered by trained health workers.
Methods The screening programme, which started in 2017, used four types of health worker: sampling health workers, slide preparation technicians, diagnostic health workers and cytopathologists. Sampling health workers took samples from the women on site; slide preparation technicians prepared slides for liquid-based cytology; diagnostic health workers identified negative samples and classified positive samples based on the Bethesda System after cytological assessment using online artificial intelligence; and cytopathologists reviewed positive samples and signed reports of the results online. The programme used fully automated scanners, online artificial intelligence, an online screening management platform, and mobile telephone devices to provide screening services. We evaluated the sustainability, performance and cost of the programme.
Results From 2017 to 2021, 1 518 972 women in 16 cities in Hubei Province participated in the programme, of whom 1 474 788 (97.09%) had valid samples for the screening. Of the 86 648 women whose samples were positive, 30 486 required a biopsy but only 19 495 had one. The biopsy showed that 2785 women had precancerous lesions and 191 had invasive cancers. The cost of screening was 6.31 United States dollars (US$) per woman for the public payer: US$ 1.03 administrative costs and US$ 5.28 online screening costs.
Conclusion Cervical cancer screening using artificial intelligence in Hubei Province provided a low-cost, accessible and effective service, which will contribute to achieving universal cervical cancer screening coverage in China.
Introduction
Cervical cancer is a threat to women's health. According to data released by the International Agency for Research on Cancer, the cancer research agency of the World Health Organization (WHO), 0.6 million women worldwide were diagnosed with cervical cancer and 0.3 million died from cervical cancer in 2020.1 These numbers represent 3.1% of all newly diagnosed cancers worldwide (making cervical cancer the ninth leading cancer diagnosis), and 7.7% of global female cancer deaths (making this cancer the fourth leading cause of death in women).1 WHO released the Global strategy to accelerate the elimination of cervical cancer in 2020, with the goal of eliminating cervical cancer (a rate of fewer than 4 cases per 100 000 women) by 2030....