Mega Hpv laboratories for cervical cancer control: Challenges and recommendations from a case study of Turkey

Abstract

Cervical cancer is the fourth most common cancer among women in the world. It is estimated that one woman dies every 2 min from cervical cancer. Nearly all cervical cancers are preventable by early detection and treatment through screening or HPV vaccination. In 2018, World Health Organization (WHO) made a global call for action toward the elimination of cervical cancer. Cervical cancer screening involves a complex organized program, which begins with a call/recall system based on personal invitation of eligible women, followed by participation in screening, and leading to diagnosis, treatment, and management as appropriate. An effective cervical screening program with high coverage is dependent on each country's infrastructure and human resource capacity. Efforts to develop an effective program is particularly challenging in low and middle income countries (LMIC) where resources are limited. For an effective strategy, Turkey redesigned the country's cervical screening program. The local call/recall system and centralized monitoring system of individual women were re-vamped with an automated evaluation system. The revised screening program includes the use of primary HPV testing with a well-defined protocol outlining the algorithms of management (i.e., screening intervals and referral), a single nationwide centralized diagnostic laboratory, and a sustainable agreement with the HPV diagnostics industry. This system allows for traceable, real-time monitoring of screening visits and specimens. Turkey reports on the first four years of this re-vamped organized program and shares lessons learnt from the implementation of this new program.

The meaning of high‐risk HPV other than type 16/18 in women with negative cytology: Is it really safe to wait for 1 year?

“…In a study conducted on 3.8 million women, HPV positivity was seen in 4.29% of the women, and abnormal cytology was reported in 1.32% of HPV positive women 12 . The most common HPV subtypes were HPV 16, HPV 51, and HPV 31 (20.7%, 10.8%, and 8.7%, respectively) in Turkey 12 . In the present study, the most frequent non‐16/18 hrHPV types were HPV 31 (11.9%) and HPV 51 (10.5%).…”

“…From 2016 onward, primary cytology was replaced by primary hrHPV testing and, an HPV‐based screening program with long intervals was introduced into cervical cancer screening in the Netherlands 11 . Turkey has a government‐mandated protocol of primary screening with HPV testing every five years since 2014 12 . At screening, two samples are taken from each woman, one for HPV, and one for cytology.…”

Cancer Screening in the Coronavirus Pandemic Era: Adjusting to a New Situation

“…Triaging HPV-positive women with HPV 16/18 genotyping and cytology (only for those HPV-positive women negative on HPV 16/18) reduced colposcopy referrals by nearly two-third in the screening program in Turkey. 18 Those with suspected high-grade lesions or cancer on cytology should be given priority appointment for colposcopy over those having low-grade abnormalities. 19 Outreach VIA, colposcopy, and treatment services, which do not rely on electricity and combine all these interventions in a single visit, could provide a viable alternative to clinic visits in resource-constrained settings.…”

HPV infection - Screening, diagnosis and management of HPV-induced lesions

“…Cervical cancer is a public health problem worldwide and the fourth most common type of tumor among women, with 500,000 new cases and 250,000 deaths per year. (3) In Brazil, it is the third most common cancer in women. According to the National Cancer Institute, estimates for 2020 are of 16,590 new cases; and 6,526 deaths occurred in 2018.…”

“…(6) The organized screening program has reached more women, showing high coverage of the territory. (3,5) What is the target population for screening and how often should it be done?…”