Utility of high-risk HPV (HR-HPV) and Liquid Based Cytology (LBC) for cervical cancer screening of unscreened women over 29 years old in Harare, Zimbabwe

Abstract

Background: Approximately 50% of cervical cancer cases are diagnosed in women who have not been screened previously. It has been observed in some centres that co-testing with LBC and HR-HPV identifies those with current precancerous lesions and those with an active HR-HPV for management. The procedure has not been examined in our setting so as to enable consideration for use in the diagnostic process.
Objective: To determine LBC and HR-HPV findings in women over 29 years old who had no previous screening for cervical cancer at Cimas MEDLABS.
Design: Cross sectional descriptive study
Materials and Methods: Women with no prior history of cervical screening were recruited into this study. A Thin Prep 2000 machine was used process the LBC specimens. The 2014 Bethesda System was used to report the smears. HR-HPV DNA testing was done using the Cepheid Xpert HPV qualitative test.
Results: There were 1446 co-tested specimens; the mean (SD) age of study participants was 38.7 (8.3) years and the range was 30-79 years. Tests results showed the following: NILM/HPV- (n=1149, 79.5%), NILM/HPV+ (n=265, 18.3%), ≥ ASCUS/HPV+ (n=23, 1.6%), ASCUS/HPV- (n=9, 0.6%). The ≥ ASCUS lesions were distributed as follows: ASCUS = 25, LSIL = 6 and HSIL = 1. The co-testing approach identified 297 (20.5%) women with a higher risk of developing cervical cancer (≥ ASCUS and HPV+ patients) for follow up according to established protocols.
Conclusion: Approximately a fifth (20.5%) of unscreened women had either a precancerous lesion or an active HR-HPV infection and  required follow.