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Year : 2014  |  Volume : 3  |  Issue : 3  |  Page : 145-146

Human papillomavirus screening: Time to add molecular methods with cytology

Department of Biochemistry, Centre of Excellence in Molecular Biology and Regenerative Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India

Date of Web Publication13-Aug-2014

Correspondence Address:
Devananda Devegowda
Department of Biochemistry, Centre of Excellence in Molecular Biology and Regenerative Medicine, JSS Medical College, JSS University, Mysore, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2278-344X.138585

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How to cite this article:
Devegowda D, Doddamani P, Vishwanath P. Human papillomavirus screening: Time to add molecular methods with cytology. Int J Health Allied Sci 2014;3:145-6

How to cite this URL:
Devegowda D, Doddamani P, Vishwanath P. Human papillomavirus screening: Time to add molecular methods with cytology. Int J Health Allied Sci [serial online] 2014 [cited 2023 Mar 30];3:145-6. Available from: https://www.ijhas.in/text.asp?2014/3/3/145/138585

Cervical cancer is a major public health problem in developing countries like India, human papillomavirus (HPV) being its major etiological agent. HPV is an epitheliotropic, nonenveloped DNA viruses, which causes a wide range of diseases in humans, such as cervical cancer, anogenital cancer, head and neck cancer, skin or genital warts and recurrent respiratory papillomatosis. The effect of the infection depends on type of HPV and site of infection as well as different host factors. HPV infection is a central carcinogenic factor in the cervical cancer, which is one of the most common cancers in women. According to WHO/ICO Information Center on HPV and Cervical Cancer (HPV Information Center) 2014, cervical cancer ranks as the second most common cancer among women in India and the first most frequent cancer among women between 15 and 44 years of age. India has nearly 432 million women aged 15 years and above who are at risk of developing cervical cancer. Current estimates indicate approximately 122,844 new cases identified among which 67,477 die from the disease annually in India. Approximate number of new cervical cancer cases and deaths has been projected as 203,757 and 115,171, respectively in India for 2025. About 7.9% of women in the general population are estimated to harbor cervical HPV infection at a given time. HPV 16 and 18 account for nearly 76.7% of cervical cancer in India. A recent study estimates that the prevalence of HPV infection in men is equal to that of women. HPV presence in the genital tract has been detected in up to 73% of healthy men. Like other sexually transmitted infections, HPV may be transmitted more readily from men to women than from women to men; this further increases the prevalence, making HPV the most common sexually transmitted infection, with no specific treatment. [1]

The main access for the prevention and detection of cervical cancer has been through community-based screening programs using cytology-based screening (Pap-smear) has led to a significant reduction of the incidence and mortality rates of cervical cancer. [2] Cervical cancer is preventable by a more effective screening and intervention system. Therefore, the lowest incidence and mortality rates are seen in countries like USA where general population is regularly screened on the community basis. In developing countries like India where cervical cancer is a major public health problem in women, no such coordinated screening program is enforced at the national level. This is mainly because of the large population, high cost, lack of skilled manpower, and essential infrastructure, but can also be attributed to lack of proper planning and awareness among the general populations. Moreover, the Papanicolaou-smear test (Pap-smear test) or visual inspection with acetic acid (VIA) itself has several disadvantages, such as high false-negative results, low sensitivity (only 45% vs. 96% compared with HPV DNA testing), poor quality control, subjective interpretation, inability to identify potential HPV infection, and low predictive value. As a result of which one-third of women who progress to cervical cancer have a normal Pap-smear. This huge indifference thus enhances the need for better screening test.

Human papillomavirus detection based on molecular techniques allows for its accurate detection and genotyping. Molecular methods for HPV DNA detection are broadly divided into signal and target amplification assays. [3] The most common example for the target amplification assay is polymerase chain reaction (PCR) and its types like: Nested PCR, multiplex PCR, quantitative PCR, and reverse transcription PCR. The only examples of kits based on signal amplification are Hybrid Capture 2 (HC2) system (Digene Corporation, Gaithersburg, MD, USA) and Cervista HPV HR test (Hologic, WI, USA) which are the only methods that currently have Food and Drug Administration approval for diagnostic testing in the United States that detect the 13 and 14 high-risk HPV types, respectively. Amplification of HPV L1 gene followed by reverse line-blot hybridization using linear array HPV Genotyping (Roche Molecular Diagnostics, Branchburg, NJ, USA) and the InnoLiPA HPV Genotyping (Innogenetics, Belgium) can be used to detect 37 and 28 types, respectively.

Cervical cancer has a major impact on developing countries like India, where screening programs are not well-established or effective. In addition to Pap-smear as one of the basic screening test; molecular technique like PCR has been found to be highly sensitive due to its possibility to detect very low levels of HPV DNA and in differentiating high-risk HPV genotypes 16 and 18, which are considered as high-risk factors for cervical cancer. The potential of cytology-based simple, cost-effective Pap-smear test or VIA cannot be underestimated, but in the due course of time it is highly likely that the number of false-negative tests and inability to detect high-risk strains of HPV by Pap-smear would increase the risk of invasive cervical cancers in women. Now time has come for India for the implementation of cytology-based screening tests along with high-risk HPV detection by using molecular techniques as a primary screening test as it provides superior protection against cervical (pre)-cancerous lesions. This would help lower the prevalence of the growing risk of cervical cancers in women in Indian population. This seems to be a distant dream unless the Government at national level and the community at large makes the efforts in making cytology-based screening and molecular techniques more affordable and cost-effective for the general population. This effort would be highly profitable as it would lessen the burden of medical cost of treating the cervical cancers.

  References Top

1.Bruni L, Barrionuevo-Rosas L, Serrano B, Brotons M, Cosano R, Muñoz J, et al. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human papillomavirus and related diseases in India. Summary Report 2014-03-17.  Back to cited text no. 1
2.Dijkstra MG, Snijders PJ, Arbyn M, Rijkaart DC, Berkhof J, Meijer CJ. Cervical cancer screening: On the way to a shift from cytology to full molecular screening. Ann Oncol 2014;25:927-35.  Back to cited text no. 2
3.Arney A, Bennett KM. Molecular diagnostics of human papillomavirus. Lab Med 2010;41:523-30.  Back to cited text no. 3

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