Cervical cancer screening: Twelve years experience with high-risk population of southern Mexico.

Abstract

1579 Background: Cervical cancer is still the main cause of death from cancer in indigenous population and rural communities in Mexico. We have evaluated both screen-and-treat colposcopy and oncogenic human papilloma virus (HPV)-DNA testing as potential screening programs in high-risk population. Our experience has been previously reported (2006 and 2008 ASCO Annual Meetings; Abstracts 5012 and 16519, respectively). In this study we report a follow-up of both strategies. Methods: Between 12/2002 and 11/2013, women were offered colposcopy. From 08/2006 to 11/2013, HPV-DNA testing (Hybrid Capture II (hC2) assay (Digene Corp, Gaithersburg, MD, USA) was offered to women aged 14 to 89 years. Criteria for colposcopy diagnosis, cervical cytology, therapy for HPV diagnosis, CIN2 and CIN 3, and the methodology for (Hybrid Capture II (hC2) assay has been reported elsewhere. Women were followed in their communities Results: 17,471 women (median age 39 years, range: 14–87) were underwent colposcopy. 14,487 (83%) of them were evaluated between 2002 and 2008, and 2985 (17%) from 2009 to 2013. The median follow-up was 8 years (range 5-11) and 3 years (range 0-5), respectively. Abnormal colposcopy (HPV, CIN 1, CIN 2 or CIN 3), was diagnosed in 2,528 (14%) out of 14,487 women and 45 (0.31%) had carcinoma. 411 (14%) out of 2,985) women were diagnosed as having an abnormal colposcopy and 11 (0.36%) had carcinoma. 1,110 women were evaluated with the oncogenic HPV-DNA testing. 807 (73%) women were ≥ 30 years old years and 303 (27%) were younger 30 years old. HPV-DNA testing was positive in 134 (16%) and 97 (32%) women, respectively. In women ≥ 30 years old who had a normal colposcopy (n=681), 96 (11.8%) of them had a positive HPV test and in 38 (4.7%) of those who had an abnormal colposcopy. In women younger 30 years old HPV test was positive in 45 (14.85%) women who had a normal colposcopy (n=179) and in 52 (17.16%) diagnosed as having abnormal colposcopy. No new cervical cancer cases have been reported in the follow-up. Conclusions: Screen-and-treat colposcopy and oncogenic HPV testing are feasible strategies for cervical cancer screening in selected high-risk population and an alternative to cytology-based screening programs