(I) Organizational leadership.
1. The Ministry of Health and the All-China Women's Federation (ACWF)*** together set up a Leading Group for the "Two Cancers" Screening Work for Rural Women, with the Vice-Minister in charge of the Ministry of Health as the leader and the Vice-Chairman of the All-China Women's Federation (ACWF) as the vice-chairman. The office is located in the Department of Women and Social Affairs of the Ministry of Health. It is responsible for organizing, coordinating, supervising and managing the "two cancers" screening work for rural women nationwide; it is responsible for organizing and formulating the work plan for the "two cancers" screening work for women; organizing the establishment of an expert technical steering group to guide the quality control work of the project; and managing the relevant information. The Breast Cancer Screening Program is under the specific responsibility of the Bureau of Disease Control of the Ministry of Health.
2. The All-China Women's Federation cooperates with the Ministry of Health to do a good job of organizing and mobilizing and publicizing the project, and the two departments work closely together to set up a working mechanism of division of responsibility and coordination to ****together push forward the implementation of the rural women's "two cancers" screening project.
3. Health administrative departments at all levels coordinate with the Women's Federation and other relevant departments to form a leading group for rural women's "two cancers" screening work in the region, which is responsible for organizing, coordinating and supervising and guiding the work of rural women's "two cancers" screening work in the region; formulating the implementation plan; implementing the relevant funding; determining the amount of funds to be allocated to the project; and establishing a mechanism for coordinating and cooperating. It formulates implementation plans, implements relevant funds, identifies institutions for women's "two cancers" examination and diagnosis, and establishes a referral mechanism, organizes and sets up expert and technical steering groups, carries out personnel training, manages relevant information, supervises the implementation of the project, and informs the Leading Group of the Ministry of Health's Work on Rural Women's "Two Cancers" Examination of its work on a regular basis.
(2) Responsibilities of relevant organizations.
1. Maternal and child healthcare institutions and disease prevention and control institutions at all levels shall, according to the requirements of the Leading Group, formulate work plans and processes for cervical cancer and breast cancer screening in their respective jurisdictions; be responsible for providing health education, counseling and technical services for the "two cancers" screening; be responsible for collecting, summarizing, analyzing and reporting relevant information; develop and produce publicity materials for health education; organize experts to carry out the "two cancers" screening; and organize experts to carry out the "two cancers" screening for rural women. It is responsible for providing health education, consultation and technical services for "two cancers" screening; collecting relevant information, summarizing, analyzing and reporting; developing and producing health education promotional materials; organizing experts to provide technical guidance and quality control for "two cancers" screening; and making follow-up visits for abnormal cases.
2. Medical and health institutions at the county level and above provide appropriate diagnosis for the suspected cases detected by the examination, and provide timely feedback of the diagnosis to the maternal and child health institutions or disease prevention and control institutions that referred the patients.
(3) expert technical steering group responsibilities.
The expert technical steering groups at all levels are responsible for training and assessing the personnel responsible for women's "two cancers" screening and guiding the completion of quality control work in accordance with the unified requirements of the State.
(4) The workflow of the "two cancers" examination.
1. Selection of Crowd
Street offices, township governments and villagers' committees organize relevant personnel, with the cooperation of public security, women's federation, family planning and civil affairs departments, to register women of the appropriate age who are eligible for the examination within the jurisdiction, mobilize them to take the examination, sign the "Informed Consent for Voluntary and Free Examination", and organize the arrangement for the subject of the examination to go to the designated healthcare institutions for the examination with the person's ID card or household registration book. The organization will arrange for the examinees to go to the designated medical and health institutions with their ID cards or household registration books for examination.
2. Examination Procedure
2.1 Cervical Cancer Examination Procedure
2.1.1 Township health centers or community health service institutions (or designated medical institutions for initial examination) shall be responsible for the gynecological and pelvic examination of the examined women, the vaginal/cervical secretion wet slice microscopic examination/granular staining examination, and cervical exfoliative cell examination in terms of material taking, smearing, and fixation (or cervical acetate staining examination/complex iodine staining examination). (or cervical acetic acid staining examination/complex iodine staining examination), and fill in the relevant case registration form. Centrally deliver the fixed cervical exfoliative cell examination smear specimens, cervical cytology examination application form and relevant contact cards to designated healthcare institutions at county level and above for cervical exfoliative cell Pap smear staining and TBS descriptive report. Township health centers or community health service organizations (or designated medical institutions for initial examination) that conduct cervical acetic acid staining examination/complex iodine staining examination refer the suspects to designated medical and health care institutions at the county level and above for colposcopy examination. Conditional township health centers or community health service institutions, recognized by the county-level health administrative department, can carry out cervical exfoliated cell staining and reading.
2.1.2 Healthcare institutions at the county level and above are responsible for performing smear staining and TBS descriptive report of cervical exfoliated cells for Pap smear examination and filling in the form of cervical cytology examination. Suspicious or abnormal cases detected by the examination are registered, and the report results are sent back to the township health centers or community health service institutions (or designated primary health care institutions) in the jurisdiction where the subject is located, so that they can complete the relevant contents of the case registration form. Township health centers and community health service organizations (or designated primary examination medical institutions) are responsible for feeding back the examination results to the examined subjects in their jurisdictions and notifying suspicious and abnormal persons to go to the designated medical and health institutions for colposcopy.
2.1.3 Healthcare institutions at the county level and above are responsible for providing colposcopy to women whose results of cervical cytology and cervical acetic acid staining examination/complex iodine staining examination are suspicious or abnormal. For those whose colposcopic examinations are suspicious or abnormal, they conduct histopathological examinations and register the results of the colposcopic and pathological examinations, and at the same time send the results of the examinations back to the township health centers or community health service institutions (or the designated medical institutions for initial examinations) in the districts in which the subjects are located, so that they can complete the filling in of the relevant contents of the case registration form. Township health centers and community health service organizations are responsible for feeding back the results of the examination to the examinees in their jurisdiction and urging the diagnosed patients to undergo further treatment.
2.1.4 Township health centers or community health service organizations (or designated primary examination medical institutions) are responsible for conducting follow-up visits to suspected or confirmed patients, and recording the results of follow-up visits in the case registration form.
2.2 Breast Cancer Screening Process
2.2.1 Township health centers or community health service organizations are responsible for the initial screening of women. Professionals will register and fill out relevant case registration forms for the examinees, and at the same time conduct breast cancer health education, questionnaire surveys and assessment of high-risk groups. The examining physicians of the trained township health centers or community health service institutions will examine and palpate the breasts of all the examined women, record the size and hardness of the breasts, and pay special attention to some minor abnormal symptoms and signs that are not emphasized in the breasts, and then the examining physicians will fill in the "Breast Clinical Examination Form", and those who are judged to be high-risk groups and those who are suspected of having suspicious or abnormal results of the manual examination will need to undergo the next step of breast ultrasound examination.
2.2.2 Township health centers or community health service institutions are responsible for the color ultrasound examination of high-risk groups and those with suspicious or abnormal results of manual diagnosis. Color ultrasound examination equipment requirements: high-frequency probe digital color ultrasound (mid-range and above). If the local health center is unable to meet the equipment requirements, it is necessary to transfer the subject to a designated county-level or above health care institution for examination. The ultrasound doctor is responsible for filling in the Diagnostic Report of Ultrasound Examination. The township health center or community health service organization is responsible for filling in the relevant contents of the case registration form and feedback the examination results to the examinee within the jurisdiction, and notify the suspicious and abnormal persons to go to the designated medical institution for mammography.
2.2.3 Designated medical and health institutions at the county level or above are responsible for providing mammograms to women whose ultrasound results are suspicious or abnormal. Mammography equipment requirements: conventional mammography or digital mammography (DR). Histopathological examinations are conducted on those with suspicious or abnormal mammograms, and the results of the examinations are registered, and the results are sent back to the township health centers or community health service agencies in the jurisdiction where the subjects are examined, so that they can complete the relevant contents of the case registration form. Township health centers and community health service organizations are responsible for sending the results of the examination back to the examinees in their jurisdictions and urging the diagnosed patients to undergo further treatment.
2.2.4 Township health centers or community health service organizations are responsible for conducting follow-up visits to the examination, diagnosis and treatment of suspected or confirmed patients, and recording the results of the follow-up visits in the case registration form.
(v) Information collection and management.
1. Information collection and reporting channels.
Medical and healthcare institutions undertaking the task of rural women's "two cancers" examination should properly save individual examination data, do a good job of keeping confidentiality, and report the data on cervical and breast cancers to the local women's and children's healthcare institutions and disease prevention and control institutions on a quarterly basis, respectively.
Maternal and child health care institutions and disease prevention and control agencies at all levels collect the corresponding information and data as required. Provincial maternal and child health care institutions and disease prevention and control institutions are responsible for reporting the summary data to the Maternal and Child Health Center of the Chinese Center for Disease Control and Prevention (CDC) and the Chinese Anti-Cancer Association (CACA) respectively, and then report them to the Ministry of Health after summary. The content of the provincial quarterly summary statistical table of the cervical cancer screening program is shown in Annex 8.
2.
Submitted separately by provinces (autonomous regions and municipalities). February 1 each year before the fourth quarter of the previous year, May 1 before the first quarter of the current year, August 1 before the second quarter of the current year, November 1 before the third quarter of the current year.
(vi) Quality control.
1. The Ministry of Health has formulated technical specifications for the "two cancers" screening program for rural women.
2. Health administrative departments at all levels regularly carry out quality control of medical and health institutions within their jurisdiction that are responsible for the "two cancers" screening tasks, standardize the operation procedures and review the results of the screening tests; they also convene regular meetings on quality control, notify the quality of the screening tests and put forward improvement measures.
3. Quality control standards and methods.
Cervical cytology quality control: positive smears are sampled at 20%, negative smears are sampled at 5%-10%, and all smears are reviewed by experts.
Gynecology quality control: checking the disinfection and isolation status of the site, observing the operation procedures and filling out of cards of all gynecological examiners, reviewing 5%-10% of examined women on the spot, and the diagnosis result compliance rate reaches 80%.
Quality control of breast palpation examination and ultrasound examination, all examiners must be specially trained and tested.
Breast ultrasound quality control: observing the operation of all ultrasound doctors, experts take 5%-10% of the examined women on the day of quality control for on-site review, and the diagnostic result compliance rate reaches 80%.
Suspicious case follow-up: follow-up of suspicious cases found during the examination, with a follow-up rate of 90%.
Data quality control: randomly select 1%-5% of the previous month's various forms for inspection and review, with errors and omissions of less than 5% and a completeness rate of 95%.
(vii) Funding management.
1. The funds required for the implementation of the project by the central financial and local financial **** the same. The central financial subsidies have been issued, see "Ministry of Finance and Ministry of Health on the issuance of 2010 public **** health subsidies notice" (Caixa [2010] No. 38). Local health administrative departments at all levels should coordinate with the financial sector, implement relevant supporting funds, fully guarantee the project funds, develop specific measures for the management of project funds in their provinces (autonomous regions and municipalities), and strengthen the use and management of funds. Local health administrative departments at all levels should coordinate the use of subsidies at all levels, the implementation of supervision, training and publicity and mobilization and other related work to ensure the smooth implementation of the project.
2. Medical and health institutions undertaking the task of rural women's "two cancers" examination regularly report the number of examinees and testing items to the county-level health departments, and after examination and approval by the county-level health and finance departments, the finance departments will allocate the special subsidy funds to the corresponding medical and health institutions according to the workload through centralized payment from the state treasury. Healthcare organizations. Intermediary organizations can also be commissioned to carry out the audit, approved by the health and finance departments after the allocation.
3. The special subsidy funds must be earmarked for specific purposes, and no unit or individual shall in any way retain, squander or misappropriate the special subsidy funds. The management, use of special subsidies and beneficiary women should be regularly announced to the community to accept public supervision. Deliberate misrepresentation of the relevant figures and circumstances of fraudulent special subsidies, or retained, squeezed and misappropriated special subsidies, in accordance with the relevant laws and regulations, in addition to ordering correction, recovery of the relevant financial resources, but also in accordance with the provisions of the relevant units and personnel responsibility.