Human Papillomavirus DNA Versus Papanicolaou Screening Tests for Cervical Cancer in a Sample of Iraqi Patients

Abstract

Background: To determine whether testing for DNA of oncogenic human papilloma viruses (HPV) is superior to the Papanicolaou (Pap) test for cervical cancer screening. We report here the first screening round of the Iraqi Cervical Cancer Screening Trial. Setting: This study has conducted at Baghdad Teaching Hospital, Department of Obstetrics and Gynecology. Study Design: A Prospective study. Patient and Methods: The study population consist of 60 married women ages equal or more than 30 years. Written informed consent was obtained from all participants. Information on demographics and risk factors was obtained by a self administered questionnaire. We compared HPV testing and conventional pap testing with that of colposcopy and punch biopsy. Results: The number of women enrolled at the study, was 60 women. The mean age at enrollment was 39. 78 year and standard deviation is 8. 912. The minimum age at marriage, the maximum age, was12 and 42 respectively. The mean was 20. 87 and std. deviation was 5. 990. Parity of the women enrolled at the study, the minimum was 0, the maximum was 11, the mean was 4. 05, and standard deviation was 2. 480. The number of women used OCSPS in our study is 39 (65%) and 21 women(35%) out of 60 did not. Sixteen women (26. 7%) were smoker and 44 (73. 3%) were not smoker. Manual workers between women in our study were 32 (53. 3%), clerks were 22 women (36. 7%) and health workers number were 6 (10. 0). Sexual transmitted diseases (as documented clinically or by culture, serological and immunological tests) was reported in 14 women (23. 3%). Condom using by male partner was reported in 26 (43. 3%) and in 34 women (56. 7%) condom was not used by the women’s partner. By conventional pap test 7 cases (13. 2%) out of 53 was positive [ 6 cases (85. 7%) were diagnosed as CIN II, CINIII or CA (3 cases were diagnosed as HSIL by pap found to be sequmous cell cacinoma by biopsy and one case diagnosed as cacinoma by pap test and biopsy) &only one case (14. 3%) was normal (table10). Pap test was negative in 46 cases out of 53 total (86. 8 %), 21 cases (45. 7%) were diagnosed as CINII or CINIII and 25 cases (54. 3%) of the negative pap proved to be normal or CINI by biopsy. Conclusion: –1. HPV DNA testing has a better sensitivity than, that of cytology. Sensitivity of the test was 89%. 2. Combination of HPV DNA test with Pap test increase the sensitivity of Pap from 22% to 89%. 3. HPV types 16, 18, 11 &6 has been detected in our community by using ISH technique, and HPV types 16 &18 (high risk)were statistically significantly associated with HSIL & Cancer (P value=0. 010), while HPV 6&11(low-risk) were not associated with these lesions(P value =0. 318, 0. 669)respectively