Cervical Cancer screening program in Hyderabad and surrounding peri-urban areas, South India: prevalence of high risk HPV subtypes
Cervical screening programs were conducted in urban and peri-urban areas of Telangana and Andhra Pradesh, during the period January 2012–March 2014. Our work was aimed at (I) identifying women with abnormal cervix upon visual inspection and pap cytology testing (II) determining the presence of HPV infection in the individual, along with sub-typing in severe pathologies and cancer, which is an established risk factor for cervical malignancy reported world-over.
A total of 530 eligible women (based inclusion criteria for participation) were screened by gynecologist. Pap smears were collected on slides and cervical swab cells were collected in a saline solution for subsequent cytological and molecular analysis. The study was approved by our Ethics committee and informed consent was obtained from the subjects. Personal and medical history of each of the eligible participants was recorded in a well-designed proforma. Data tabulation and statistical analysis was performed using MS Excel and MedCalc software.
Our program witnessed an incremental increase in the number of women accessing screening after counselling for awareness of the importance of testing. A total of 530 women were screened for Pap smear cytology. The mean age of women in the study population was 38.73yrs (+10.82). 16.41% cases showed a normal cytology, 43.39% had an inflammatory smear, 26.22% showed infection, 4.15% showed reactive cellular changes, 6.41% showed atrophy, 0.75% showed ASCUS, 1.88% showed LSIL, 0.37% showed HSIL, 0.37% showed squamous cell carcinoma. Prevalence of HPV in our study population was 14.7% (n=530). 1.8% of our subjects showed the presence of high-risk HPV subtypes; all of them were associated with an abnormal Pap cytology. HPV was shown to be associated with an infectious pap, RCC, ASCUS, HSIL, SCC (p<0.05) when compared to normal cytology (p=0.05).
Awareness and the importance of cervical examination is low. Health camps need to focus on counselling subjects about its benefits to improve their participation and ensure success of screening programs. The significant association of HPV infection with abnormal pathologies (p=0.05) and the presence of hr-HPV subtypes other than 16 and 18 (that are used for vaccination) draws attention to the need to evaluate the subtypes prevalent in our population and apply this information to cervical vaccination schemes.
Keywords Cervical, Pap cytology, HPV, High-risk subtypes
HPV- Human Papilloma Virus, hr-HPV-high risk Human Papilloma Virus, RCC-Reactive Cellular Changes, ASCUS- Atypical Squamous Cells of Undetermined Significance, LSIL-Low Grade Squamous Intraepithelial Lesion, HSIL-High Grade Squamous Intraepithelial Lesion, CIN-Cervical intraepithelial neoplasia, SCC-Squamous cell carcinoma.
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