Abstract
BackgroundCervical cancer is the second commonest female cancer in Sri Lanka. Two major drawbacks of the present cervical cancer screening programme are the suboptimal sensitivity of the pap smear and the low coverage. The objective of the study is to determine the feasibility of a new HPV/DNA test among 35 -years -old ever-married women in a district of Sri Lanka.MethodA community based descriptive cross-sectional study was conducted from 1stof July 2018 to 30th November 2018 in the public health divisions called Medical Officer of Health (MOH) areas of Kalutara district. The study population is comprised of ever-married women 35 years of age. Three women from each cluster (n = 413) were selected by consecutive sampling. A total of 918 women were recruited. HPV/DNA cervical specimen collection (n = 822) was carried out. Cervical specimens were tested by two cytoscreeners with the cobas 4800 PCR based screening machine. Clients’ perceptions and prevalence were assessed. The follow-up of women with positive HPV/DNA screening results was carried out. The operational and technical feasibility of the screening test were assessed. Data entry was done by using the statistical package IBM SPSS version 20.ResultsOverall response rate was 91.1% (n = 836). Clients’ perception was highly positive for HPV/DNA screening test procedure (99.9%, n = 821) and 99.6% (n = 819) of clients had mentioned that the HPV/DNA screening test is worthwhile to be incorporated into the National Cervical Cancer Screening program. The prevalence of HPV was 6.2% (95%CI: 6.18–6.22%). The coverage of the HPV/DNA screening was 89.5%(n = 822). Invalid results reported were 0.12% (n = 1). The percentage of HPV/DNA test positive women who underwent pap test within 3 months of the initial screening was 100% (n = 51), while the percentage of women who attempted to get a colposcopy within the 1 month of referral was 86.7% (n = 13).ConclusionsHPV/DNA test implementation as a primary cervical cancer screening method is feasible among the 35- year age cohort of ever- married women in Kalutara district. It is necessary to further attempt alternative methods of cobas 4800 HPV/DNA test, which would be much suitable for resource-limited settings.
Highlights
Cervical cancer is the second commonest female cancer in Sri Lanka
Women with; diagnosed invasive cervical cancer, pregnancy, ≤ 3 months in the postpartum period, hysterectomy, per vaginal bleeding, active infection at the time of examination evidenced by medical records or by visual inspection, currently on treatment for human papillomavirus infection (HPV) infection, diagnosed physical or mental retardation or disease status and women who did not reside within the district continuously for ≥3 months before the date of the survey were excluded from the study at the field and clinic settings
The clinical usefulness of HPV triage for women with Atypical Squamous Cells of Undetermined Significance (ASCUS) cytology even with the carefully validated test was limited by the fact on average 43.7% were high-risk HPV positive, while the prevalence of Cervical Intraepithelial Neoplasia (CIN) II or worse was only 5.1%, in a study conducted in the United States [15]
Summary
Cervical cancer is the second commonest female cancer in Sri Lanka. Two major drawbacks of the present cervical cancer screening programme are the suboptimal sensitivity of the pap smear and the low coverage. The objective of the study is to determine the feasibility of a new HPV/DNA test among 35 -years -old ever-married women in a district of Sri Lanka. Cervical cancer is the 2nd leading cause of female cancer in Sri Lanka and women at risk for cervical cancer are more than 8.4 million [1]. Most women even infected with high-risk HPV types never develop cervical cancer, as most of this infection regardless of HPV type is shortlived and the body eliminates them spontaneously in ≤2 years. Some carcinogenic genotypes are classified as “high risk” (16,18,31,33,35,39,45,51,52,56,58 and 59) as there is an evidence of increased risk association between HPV infection and cervical cancer [4]. Compared to other carcinogenic genotypes of HPV infection, serotypes 16 and 18 have 190.3 times increased risk of developing cervical cancer [5]. HPV serotypes 26, 53, 66, 68, and 72 are considered as possible carcinogens but their role related to cervical carcinogenesis is unclear [6]
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