Human Papilloma Virus (HPV) DNA Testing and HPV-16/-18 Genotyping Based Cervical Cancer Screening among Gynaecology Clinic Attendees in Two Selected Hospitals, Yangon

Mu Mu Shwe1*, Lynn Pa Pa Aye1, Kham Mo Aung1, Nu Nu Lwin1, Htwe Htwe Nyunt1, Saw Kler Ku2, Khin May Thin2 and Win Maw Tun1

Myanmar Health Sciences Research Journal, Vol. 34, No. 1-3, 2022

Screening women for the presence of Human Papilloma Virus (HPV) is a critical aspect for secondary prevention and early treatment of cervical cancer.  This study was aimed to conduct HPV-DNA testing and HPV-16/-18 genotyping based cervical cancer screening among married women and to identify the cervical cytological abnormalities among women who have HPV- infection. It was a prospective cross-sectional descriptive study. Total of 220 married women (median-age 40 years; range 30-60) who had no previous history of cervical cancer screening were studied in two selected-hospitals, Yangon in 2018-2019. Cervical cells were obtained from the cervix by sterile disposable cytobrush and collected in cell-collection-media. HPV-DNA testing and HPV-16/18 genotyping was performed using Cobas4800 system. It is an automated real-time polymerase chain reaction and nucleic acid hybridization test for detection of 14 HR-HPV genotypes. It specifically detects genotypes HPV-16 and HPV-18 while concurrently detecting other 12-HR-HPV types (-31, -33 ,-35, -39, -45, -51, -52, -56 ,-58, -59, -66 and -68) as pooled-12-HR-HPV types. Overall, HPV was determined in 10% (22/220) of screened women. Among HPV positive cases, 50% of cases were vaccine preventable HPV genotypes i.e., HPV-16 was 32% (7/22) and HPV-18 was 18% (4/22) while pooled-12-HR-HPV genotypes were 50% (11/22). Among HPV positive cases, 95.5% (21/22) had cervical cytological abnormalities comprising 27.3% (6/22) had high-grade squamous intraepithelial lesion (HSIL), 45.5% (10/22) had low-grade squamous intraepithelial lesion (LSIL) and 22.7% (5/22) had atypical squamous cells of undetermined significance (ASCUS). Only 4.5% (1/22) were negative for intraepithelial lesion or malignancy (NILM).

According to Global Cancer Statistics 2020, cervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women worldwide in 2020. Cervical cancer is the most commonly diagnosed cancer in 23 countries and is theleading cause of cancer death in 36 countries with the vast majority of these countries found in sub-Saharan Africa, Melanesia, South America, and South-Eastern Asia.¹

Study population and design

This study was a cross-sectional descriptive study. Total of 220 married women (median-age 40 years; Range 30-60) who had no previous history of cervical cancer screening were studied in OPD of North Okkalapa General and Teaching Hospital and Sanpya General Hospital (Thingangyun) in 2018-2019.

After obtaining a written informed consent,  a thorough history was taken using structured-proforma. Then, speculum examination was performed under good light source. Cervical cells were obtained from the cervix by sterile disposable cytobrush and collected in Cobas PCR-cell-collection-media.Those samples were sent to the Technology Development Division, Department of Medical Research (DMR), Yangon at room temperature. Then, samples were stored in 4°C prior to testing Cobas HPV test and LBC.

Recently in 2020, WHO announced the global strategy to eliminate cervical cancer: as follows (1) a vision of a world where cervical cancer is eliminated as a public health problem (2) a threshold of 4 per 100,000 women-year for elimination as a public health problem (3) the following 90–70–90 targets that need to be met by 2030 for countries to be on the path towards cervical cancer elimination: (a) 90% of girls were fully vaccinated with the HPV vaccine by age 15; (b) 70% of women are screened with a high-performance test by 35, and again by 45 years of age; (c) 90% of women identified with cervical disease receive treatment (4) a mathematical model that illustrates the following interim benefits of achieving the 90-70-90 targets by 2030 in low and lower middle-income countries; (a) median cervical cancer incidence rate is projected to fall 10% by 2030, 70% by 2045 and more than 90% by 2120, averting more than 70 million new cases of cervical cancer (b) cumulative number of cervical cancer deaths averted will be approximately 2 million by 2040, 4.5 million by 2050, 39 million by 2100 and 62 million by 2120.⁹

We would like to express their sincere gratitude to Director General, Department of Medical Research for allowing to conduct this
study. We are much grateful to all Obstetric and Gynecologists, midwifes from Out Patient Departments of North Okkalapa General and Teaching Hospital and Sanpya General Hospital (Thingangyun) and all Research Assistants from Technology Development Division, Department of Medical Research
and all the women participating in
this research.

The authors declare that they have no competing interests.

1.       Sung H,  Ferlay J, Siegel RL,  Laversanne M, Soerjomataram I & Ahmedin Jemal A Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of incidence and mortality world-wide for 36 Cancers in 185 Countries.  CA Cancer Journal for Clinicians. 2021; 71(3): 209-249 https:// doi.org /10.3322/caac .21660.

2.       Bruni L, Albero G, Serrano B, Mena M, Collado JJ, Gómez D, et al. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and related diseases     in     the     World.     Summary    Report 22 October 2021. [Internet] Available from: https://hpvcentre.net/ statistics/ reports /XWX.pdf

3.       Bruni L, Albero G, Serrano B, Mena M, Collado JJ, Gómez D, et al. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human papillomavirus and related diseases in Asia. Summary Report 22 October
2021. [Internet] Available from:
https:// hpvcentre .net /statistics/ reports /XSX.pdf