Initial Results of Population Based Cervical Cancer Screening Program Using Hpv Testing in One Million Turkish Women

Abstract

To evaluate the Turkey's nationwide HPV DNA screening program on the basis of first 1 million screened women. Women over age 30 were invited for population based screening via HPV DNA and conventional cytology. Samples were collected by family physicians and the evaluations and reports had been performed in the National Central HPV laboratories. The acceptance rate for HPV based cervical cancer screening after first invitation was nearly 36.5%. Since HPV DNA tests have been implemented, cervical cancer screening rates have shown 4–5‐fold increase in primary level. Through the evaluation of all, HPV positivity was seen in 3.5%. The commonest HPV genotypes were 16, followed by 51, 31, 52 and 18. Among the 37.515 HPV positive cases, cytological abnormality rate was 19.1%. Among HPV positive cases, 16.962 cases had HPV 16 or 18 or other oncogenic HPV types with abnormal cytology (>ASC‐US). These patients were referred to colposcopy. The colposcopy referral rate was 1.6%. Among these, final clinico‐pathological data of 3.499 patients were normal in 1.985 patients, CIN1 in 708, CIN2 in 285, CIN3 in 436 and cancer in 85 patients and only pap‐smear program could miss 45.9% of ≥CIN3 cases. The results of 1 million women including the evaluation of 13 HPV genotypes with respect to prevalence, geographic distribution and abnormal cytology results shows that HPV DNA can be used in primary level settings to have a high coverage rated screening program and is very effective compared to conventional pap‐smear., What's new? , In Turkey, a cervical cancer screening program using Pap smear reached only a tiny proportion of the nation's women. To sidestep the logistical challenges that hindered that approach, these authors investigated a population wide HPV testing program. HPV testing is much less expensive and easier to automate than cytological testing. The screening rates have increased 5‐fold over the cytology‐based screening program, and the HPV based program made better use of the limited personnel available to interpret cytological test results. Other developing countries looking to implement cervical cancer screening programs could look to Turkey's system as a successful model.