Abstract
BackgroundCervical cancer ranks second among all cancers reported in Sri Lankan women. This study assessed the prevalence and type-distribution of human papillomavirus (HPV) among Sri Lankan women with invasive cervical cancer (ICC) and pre-cancerous lesions.Methods114 women aged 21 years and above, hospitalized in the National Cancer Institute, Sri Lanka with a diagnosis of ICC or cervical intraepithelial neoplasia (CIN) 2/3 were prospectively enrolled between October 2009 and September 2010 (110430/NCT01221987). The cervical biopsy or excision specimens collected during routine clinical procedures were subjected to histopathological review. DNA was extracted from samples with a confirmed histological diagnosis and was amplified using polymerase chain reaction and HPV DNA was detected using Enzyme Immuno Assay. HPV positive samples were typed using reverse hybridization Line Probe Assay.ResultsOf the cervical samples collected, 93.0% (106/114) had a histologically confirmed diagnosis of either ICC (98/106) or CIN 2/3 (8/106). Among all ICC cases, squamous cell carcinoma was diagnosed in the majority of women (81.6% [80/98]). HPV prevalence among ICC cases was 84.7% (83/98). The HPV types most commonly detected in ICC cases with single HPV infection (98.8% [82/83]) were HPV-16 (67.3%) and HPV-18 (9.2%). Infection with multiple HPV types was recorded in a single case (co-infection of HPV-16 and HPV-59).ConclusionsHPV was prevalent in most women with ICC in Sri Lanka; HPV-16 and HPV-18 were the predominantly detected HPV types. An effective prophylactic vaccine against the most prevalent HPV types may help to reduce the burden of ICC disease.
Highlights
Cervical cancer ranks second among all cancers reported in Sri Lankan women
Women were excluded from the study if they had received previous vaccination against human papillomavirus (HPV), prior chemotherapy or radiotherapy for invasive cervical cancer (ICC), or if they had a history of recurrent episodes of ICC or cervical intraepithelial neoplasia (CIN) 2/3
A definite pathological diagnosis of ICC or cervical intraepithelial neoplasia 2/3 (CIN 2/3) was not confirmed in eight women due to insufficient ICC/CIN samples left in cervical biopsy specimen collected, the original cervical specimen was missing when the tissue blocks were prepared
Summary
This study assessed the prevalence and type-distribution of human papillomavirus (HPV) among Sri Lankan women with invasive cervical cancer (ICC) and pre-cancerous lesions. According to the World Health Organization (WHO) estimates, ICC ranks as the second most common cancer among women causing approximately 1,395 new cases and nearly 814 deaths annually in Sri Lanka [2]. It is a well-established fact that persistent infection with oncogenic (or high-risk) human papillomavirus (HPV) is an important contributor for the development of ICC [3,4,5]. HPV-16 and HPV-18 are the most frequently reported HPV types, causing approximately 70% of ICC cases worldwide [1,3,6]
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