Myanmar Health Sciences Research Journal
Original Articles :
Myanamr Health Research Registration 2023; 35(1-3): 10-18.
DOI:

Community-based Cervical Cancer Screening Using Cobas Human Papillomavirus (HPV) Test and Liquid Based Cytology (LBC) in Married Women Living in North Okkalapa Township, Yangon

Mu Mu Shwe1*, Kyi Kyi Nyunt2, Lin Pa Pa Aye1, Kham Mo Aung1, Myat Noe Swe2, Ni Ni Aung2, Ohnmar Sein3, Win Maw Tun1 and Kyaw Zin Thant1

Myanmar Health Sciences Research Journal, 2023; 35(1-3):10-18

ABSTRACT

Cervical cancer is caused by persistent infection with high-risk human papillomavirus (hrHPV) types. This study aimed to perform the community-based cervical cancer screening using Cobas HPV test and liquid-based-cytology (LBC) in married women by a cross-sectional descriptive method. A total of 312 married women were screened using LBC in 2017. Among them, 220 women aged between 30-49 years were also investigated using Cobas HPV test. Cervical cells were obtained from the cervix by sterile disposable cytobrush and collected in Cobas PCR-cell-collection-media. HPV DNA testing was performed by Cobas HPV Test. It is an automated, polymerase-chain-reaction and nucleic-acid-hybridization test for the detection of 14 hrHPV types in a single analysis. It identifies HPV-16 and HPV-18 specifically which are associated for over 70% of cervical cancer while concurrently detecting other 12 hrHPV types (-31,-33,-35,-39,-45,-51,-52, -56,-58,-59,-66-and-68) as pooled-12-hrHPV. In this study, hrHPV was identified in 5.5% (12/220) of women in general population of Kyauk Ye Twin Ward. Among HPV positive cases, pooled-12-hrHPV types were 66.7%, HPV-16 (25%) and HPV-18 (8.3%). Using LBC (Bethesda-system), negative-for-intraepithelial-lesion-or-malignancy (NILM) was 79.5% (248/312). Epi-thelial cell abnormalities such as atypical-squamous-cells and/or atypical-glandular-cells (ASC/AGC), low-grade-squamous-intraepithelial-lesion (LSIL) and high-grade-squamous-intraepithelial-lesion (HSIL) were detected 11.9% (37/312), 7.4% (23/312) and 1.3% (4/312), respectively.


RESULT
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INTRODUCTION
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Worldwide, cervical cancer is the fourth most common cancer among women world-wide, with an estimated 604,127 new cases and 341,831 deaths in 2020 (GLOBOCAN 2020). In Asia (SEA) incidence and morta- lity of cervical cancer are about 68,623 cases

and 38,530 deaths, respectively.1 In Myanmar, cervical cancer is the most common female cancer and the first leading cause of cancer deaths in women aged 15 to 44 years (IARC 2021). Age standardized incidence rate of cervical cancer were 22.6% in Myanmar, 17.8% in Southeast Asia and 13.3% in the world. Age standardized mortality rate of cervical cancer were 14.4% in Myanmar, 9.9% in South East Asia and 7.3% in the world.2


SUPPLEMENTARY MATERIAL
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Study population and design

This study was a community-based cross-sectional descriptive study. A total of 312 married women (mean age 45 years; range 30-64) residing in Kyauk Ye Twin Ward, North Okkalapa Township, Yangon were screened using liquid based cytology (LBC) in 2017. Among them, 220 women aged between 30-49 years were enrolled for the detection of hrHPV using Cobas HPV test.

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 solution. The samples were sent to the Technology Development Division, Department of Medical Research (DMR), Yangon at room temperature. Then, those samples were
stored in 4°C prior to testing for LBC and Cobas HPV test.


DISCUSSION
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For reducing morbidity and mortality of cervical cancer, a three prong strategy i.e, HPV vaccination, screening and cancer management should be a global health priority. In low-and middle-income countries, there is limited access to these preventative measures and cervical cancer is often not identified until it has further advanced and symptoms develop. In addition, access to treatment of cancerous lesions may be limited, resulting in a higher rate of death from cervical cancer in these countries.11


ACKNOWLEDGMENT
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The authors would like to express their sincere gratitude to administrator and staffs of Kyauk Ye Twin Ward, North Okkalapa Township for their great effort to arrange the community screening in the Kyauk Ye Twin Ward. We are much grateful to all Obstetricians and Gynecologists from North Okkalapa General Hospital, nurses from Public Health Care Center, North Okkalapa Township, and staffs from Technology Development Division, Department of Medical Research (DMR), Myanmar and all the women participating in this research.


CONFLICT OF INTEREST
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REFERENCES
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1.       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 papillo-mavirus and related diseases in the world. Summary Report 22 October 2021. 13-25.

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 papillo-mavirus and related diseases in the world. Summary Report 22 October 2021. 9-15.

3.       Einstein MH, Schiller JT, Viscidi RP, Strickler HD, Coursaget P, Tan T, et al. Clinician’s guide to human papillomavirus immunology: knowns and unknowns. The Lancet Infectious Diseases 2009; 9(6): 347-356.