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Metropolis optimizes cervical cancer screening

“Combines latest technology with cost effective reflex strategy”

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Ahmedabad, January 23, 2015: Cervical cancer is one of the leading causes of cancer deaths among women in India, with approximately 1.32 lakh new cases of cervical cancer being diagnosed and about 74,000 deaths every year. Cervical cancer is predominantly caused by Human Papillomavirus (HPV), a common viral infection, accounting for most cancer deaths in Indian women and the second most common cancer in women worldwide. The good news is that cervical cancer is preventable and is curable if detected early.

January is observed as ‘Cervical Cancer’ awareness month globally and in an effort to spread awareness about cervical cancer screening, Metropolis Healthcare Ltd, “The Pathology Specialist” presents an analysis of screening data collated over two years. Metropolis Healthcare represents an ideal spectrum of Indian women as we receive samples from across the country.

Cervical Cancer and its symptoms

Cervical cancer occurs sequentially from abnormal cells which progresses to grow out of control. When symptoms appear, the disease is usually in its advanced stage. The most common symptoms include abnormal vaginal discharge, unexpected bleeding, bleeding after menopause and pain during sexual intercourse. Having multiple sexual partners, smoking and long term usage of contraceptive pills are the major reasons contributing to the disease.

Screening Recommendations

The latest recommendations from the American Cancer Society for cervical cancer screening are as below

  • All women should begin cervical cancer screening at age 21.
  • Women between the ages of 21 and 29 should have a Pap test every 3 years. They should not be tested for HPV unless it is needed after an abnormal Pap test result.
  • Women between the ages of 30 and 65 should have both a Pap test and an HPV test every 5 years. This is the preferred approach, but it is also OK to have a Pap test alone every 3 years.
  • Women over age 65 who have had regular screenings with normal results should not be screened for cervical cancer. Women who have been diagnosed with cervical pre-cancer should continue to be screened. 

Screening Methods

Cervical cancer can be screened using different methods:

  • Conventional PAP: The Pap test can find early cell changes before they become cancerous. This aids in early treatment
  • HPV DNA Tests: The HPV (human papilloma virus) test finds certain infections that can lead to cell changes and cancer. HPV infections are very common, and most go away by themselves and don’t cause these problems. The HPV test may be used along with a Pap test, or to help doctors decide how to treat women who have an abnormal Pap test.
  • Liquid based cytology (LBC) PAP Smear:  An advanced technique that differs from conventional Pap in way of preparing cervical samples for examination in the laboratory. The biggest benefit of this test to women is that there is no uncertainty in test results or the need for a repeat sample.

 In order to understand & compare the effectiveness of two screening methods for Cancer, Metropolis shares the data on 12,603 samples processed from 2012 to 2013.

Total Samples

Age Group 2012 2013 Grand Total
Conventional LBC Total Conventional LBC Total  
20 to 30 370 228 598 627 734 1361 1959
30 to 40 723 551 1274 1275 1864 3139 4413
40 to 50 720 476 1196 1294 1460 2754 3950
50 to 60 303 171 474 588 553 1141 1615
60 to 70 95 56 151 186 190 376 527
70 to 80 25 17 42 58 39 97 139
Grand Total 2236 1499 3735 4028 4840 8868 12603

 Positive

Age Group 2012 2013 Grand Total
Conventional LBC Total Conventional LBC Total
20 to 30 3 9 12 27 27 39
30 to 40 6 15 21 10 70 80 101
40 to 50 17 21 38 20 71 91 129
50 to 60 10 10 20 9 26 35 55
60 to 70 4 2 6 2 13 15 21
70 to 80 1 2 3 2 2 5
Grand Total 41 59 100 41 209 250 350

 Total vs Positive

Screening Method Total Samples Positive Samples
Conventional PAP 6264 82
PAP with LBC 6339 268

 Findings of the study:

  • In LBC preparations the detection rate was 4.22% whilst 1.30% was abnormal in conventional smears. Chances of missing abnormalities in conventional PAP are high if the sample collection is not done meticulously.
  • A total of 350 samples were found positive for abnormalities which accounts to 2.77% of all tested samples.
  • Out of the total 350 samples that were tested positive, the age wise break up is as below
Age group Percentage
20 to 30 11.14
30 to 40 28.85
40 to 50 36.85
50 to 60 15.71
60 to 80 7.42

 In another study performed on 3,711 HPV DNA samples processed from 2011 to 2013, the HPV infection rate was about 10.34%.  HPV genotype 16 and HPV genotype 18 is commonly associated with high risk of development of cervical cancer.  Out of the 296 samples tested positive for HPV infection, 45% of the samples are associated with genotypes 16, followed by 15% of genotypes 18.

HPV Genotypes
TYPES No of positive cases
16 132
18 45
56 22
45 21
35 15
51 14
33 14
58 14
59 9
31 8
Total 294

HPV DNA testing is used as a follow up to abnormal changes detected with Pap smear screening methodology. It detects the presence of oncogenic strains of HPV in cervical cells. HPV DNA testing in itself does not detect abnormal cell changes in the cervix as the Pap smear does. A woman who tests positive for HPV still requires a Pap smear to check for possible cervical abnormalities. Isolated HPV DNA testing doesn’t allow detection of cytological abnormality. Hence Metropolis offers co-testing which combines combining latest technology with cost effective reflex strategy that aids the physician in making treatment decisions and disease management.

Commenting on the results, Dr. Kirti Chadha (Divisional Head – Oncology, Group & Surgical Pathology, Mumbai) emphasized, “Cervical cancer can be prevented if diagnosed early before the abnormal cells become cancerous. In our experience we have noted that an LBC Pap coupled with an HPV DNA i.e. Molecular Pap done every 5 years yields excellent patient compliance and assists in optimal patient management. In addition, Metropolis is the only lab in the country to offer CISH and p16INK4a to help gynecologists identify patients for therapy vis a vis active follow up.”

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