A retrospective cohort study of human papillomavirus (HPV) genotypes in women with abnormal Pap smear cytology in Turkey

Human papillomavirus (HPV) genotypes with abnormal Pap

Authors

Keywords:

human papillomavirus genotypes, cervical cancer, HPV16, HPV18

Abstract

Background/Aim: The most common genotypes of human papillomavirus (HPV) in patients with cervical cancer worldwide are HPV16 and HPV18. The persistence of these genotypes is associated with cervical cancer and detection, and HPV genotyping, particularly in women with abnormal Pap smears, has become a crucial tool for cervical cancer screening, diagnosis and management. We evaluated the overall prevalence of HPV in women with abnormal Pap smear cytology and also investigated age-specific HPV prevalence and HPV genotype distribution.

Methods: We analyzed 716 cervical smear specimens in this retrospective cohort study. Cytological diagnoses of typical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesions (LSILs), and high-grade squamous intraepithelial lesions (HSILs) were made utilizing the Bethesda System. The Papanicolaou method was used for the staining of the Pap smears. The specimens were pre-screened for HPV DNA positivity using an HC2 assay (Qiagen, USA). After the pre-screening, a Cobas 4800 HPV test system (Roche Diagnostics GmBH, Germany) was used to genotype the HPV-positive samples.

Results: Of the 716 cervical smear samples, 520 (72.6%) were found to be HPV-negative. Among the HPV-positive samples, 106 (23.2%), 57 (28.8%) and 33 (53.2%) were identified from 456 ASCUS, 198 LSIL and 62 HSIL cases, respectively. These findings revealed a gradual decrease in HPV prevalence with increased cytological grade (P<0.05). For high-risk, low-risk and high-risk/low-risk HPV types, 76 (38.8%), 78 (39.8%) and 42 (21.4) were positive according to the HC2 assay, respectively (P<0.05) Only 117 of the 196 HPV-positive samples were found to be HPV-positive with the Cobas 4800 HPV test system. HPV16 was the most prevalent type detected by the Cobas 4800 HPV test: 55 out of 117 HPV-positive smear samples across all age groups (47%). HPV16 was significantly more frequently detected in the HSIL samples than HPV18 (P<0.05). The prevalence of HPV was the highest in women with ages between 29 and 38 (71/196, 36.22%) and declined with age.

Conclusion: We found that HPV16 and HPV18 were the most prevalent genotypes of HPV in a cohort of Turkish women; HPV16 was most frequently detected in HSIL samples from women with ages between 29 and 38. We conclude that investigating the incidence of HPV16 and HPV18 genotypes will be important for implementing new programs and protocols to reduce the incidence of cervical cancer. These data may contribute to the development of preventive strategies to reduce the cervical cancer burden in Turkey.

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References

Cervical cancer. Geneva: World Health Organization; 2022 (https://www.who.int/news-room/fact-sheets/detail/cervical-cancer)

Doorbar J, Egawa N, Griffin H, Kranjec C, Murakami I. Human papillomavirus molecular biology and disease association. Rev Med Virol. 2015;25 Suppl 1:2-23. DOI: https://doi.org/10.1002/rmv.1822

Aghakhani A, Mamishi S, Sabeti S, Bidari-Zerehpoosh F, Banifazl M, Bavand A, et al. Gender and age-specific seroprevalence of human papillomavirus 16 and 18 in the general population in Tehran, Iran. Med Microbiol Immunol. 2017;206:105-10. DOI: https://doi.org/10.1007/s00430-016-0487-5

Schulze MH, Völker FM, Lugert R, Cooper P, Hasenclever K, Groß U, et al. High prevalence of human papillomaviruses in Ghanaian pregnant women. Med Microbiol Immunol. 2016;205:595-602. DOI: https://doi.org/10.1007/s00430-016-0475-9

IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Biological agents. IARC Monogr Eval Carcinog Risks Hum. 2012;100:1-441.

De Sanjosé S, Diaz M, Castellsagué X, Clifford G, Bruni L, Muñoz N, et al. Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect Dis. 2007;7:453-9. DOI: https://doi.org/10.1016/S1473-3099(07)70158-5

Aras S, Orcin E, Ozan S, Semin S. Sexual behaviors and contraception among university students in Turkey. J Biosoc Sci. 2007;39:121-35. DOI: https://doi.org/10.1017/S0021932006001258

Turkish Cervical Cancer And Cervical Cytology Research Group. Prevalence of cervical cytological abnormalities in Turkey. Int J Gynaecol Obstet. 2009;106:206-9. DOI: https://doi.org/10.1016/j.ijgo.2009.04.003

Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, Prey M, et al. The 2001 Bethesda system: terminology for reporting results of cervical cytology. JAMA. 2002;287:2114-9. DOI: https://doi.org/10.1001/jama.287.16.2114

Clavel C, Masure M, Bory JP, Putaud I, Mangeonjean C, Lorenzato M, et al. Hybrid capture II-based human papillomavirus detection, a sensitive test to detect in routine high-grade cervical lesions: a preliminary study on 1518 women. Br J Cancer. 1999;80:1306-11. DOI: https://doi.org/10.1038/sj.bjc.6690523

Bruni L, Albero G, Serrano B, Mena M, Collado JJ, Gómez D, et al. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in Turkey. Summary Report 22 October 2021. (Date Accessed 18th January, 2023) https://hpvcentre.net/statistics/reports/TUR.pdf https://hpvcentre.net/statistics/reports/TUR_FS.pdf

Bosch FX, Robles C, Díaz M, Arbyn M, Baussano I, Clavel C, et al. HPV-FASTER: broadening the scope for prevention of HPV-related cancer. Nat Rev Clin Oncol. 2016;13:119-32. DOI: https://doi.org/10.1038/nrclinonc.2015.146

Bosch FX, Qiao YL, Castellsagué X. CHAPTER 2; The epidemiology of human papillomavirus infection and its association with cervical cancer. Int J Gynaecol Obstet. 2006;94 Suppl 1:S8-S21. DOI: https://doi.org/10.1016/S0020-7292(07)60004-6

Smith JS, Melendy A, Rana RK, Pimenta JM. Age-specific prevalence of infection with human papillomavirus in females: a global review. J Adolesc Health. 2008;43:S5-S25, S25.e21-41. DOI: https://doi.org/10.1016/j.jadohealth.2008.07.009

Balanda M, Quiero A, Vergara N, Espinoza G, Martín HS, Rojas G, et al. Prevalence of human papillomavirus infection among women presenting for cervical cancer screening in Chile, 2014-2015. Med Microbiol Immunol. 2016;205:585-94. DOI: https://doi.org/10.1007/s00430-016-0473-y

Dursun P, Senger SS, Arslan H, Kuşçu E, Ayhan A. Human papillomavirus (HPV) prevalence and types among Turkish women at a gynecology outpatient unit. BMC Infect Dis. 2009;9:191. DOI: https://doi.org/10.1186/1471-2334-9-191

Dursun P, Ayhan A, Mutlu L, Çağlar M, Haberal A, Güngör T, et al. HPV types in Turkey: multicenter hospital-based evaluation of 6388 patients in Turkish gynecologic oncology group centers. Turk Patoloji Derg. 2013;29:210-6. DOI: https://doi.org/10.5146/tjpath.2013.01188

Eren F, Erenus M, Bas E, Ahiskali R, Yoldemir T. Prevalence of HPV infection by cytologic diagnosis and HPV DNA extraction and prevalence of the HPV genotypes detected in urban Turkish women. Int J Gynaecol Obstet. 2010;109:235-8. DOI: https://doi.org/10.1016/j.ijgo.2010.01.007

Ağacfidan A, Beka H, Önel M, Bilgin M, Önel D, Badur S. Kadınlarda insan papilloma virus (HPV) ve Chlamydia trachomatis araştırılması. Türk Mikrobiyoloji Cemiy Derg. 2001;40:325-7. (In Turkish).

Tuncer ZS, Boyraz G, Sahin N, Alp A. Distribution of human papillomavirus types in Turkish women. Eur J Gynaecol Oncol. 2012;33:204-6.

Demir ET, Ceyhan M, Simsek M, Gunduz T, Arlier S, Aytac R, et al. The prevalence of different HPV types in Turkish women with a normal Pap smear. J Med Virol. 2012;84:1242-7. DOI: https://doi.org/10.1002/jmv.23333

Özcan ES, Taşkin S, Ortaç F. High-risk human papilloma virus prevalence and its relation with abnormal cervical cytology among Turkish women. J Obstet Gynaecol. 2011;31:656-8. DOI: https://doi.org/10.3109/01443615.2011.597460

Yuce K, Pinar A, Salman MC, Alp A, Sayal B, Dogan S, et al. Detection and genotyping of cervical HPV with simultaneous cervical cytology in Turkish women: a hospital-based study. Arch Gynecol Obstet. 2012;286:203-8. DOI: https://doi.org/10.1007/s00404-012-2280-z

Giuliano AR, Harris R, Sedjo RL, Baldwin S, Roe D, Papenfuss MR, et al. Incidence, prevalence, and clearance of type-specific human papillomavirus infections: the young women's health study. J Infect Dis. 2002;186:462-9. DOI: https://doi.org/10.1086/341782

Clifford GM, Smith JS, Plummer M, Muñoz N, Franceschi S. Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis. Br J Cancer. 2003;88(1):63-73. DOI: https://doi.org/10.1038/sj.bjc.6600688

Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, Winer R, et al. Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: a meta-analysis update. Int J Cancer. 2007;121:621-32. DOI: https://doi.org/10.1002/ijc.22527

Gültekin M, Akgül B. HPV screening in Islamic countries. Lancet Infect Dis. 2017;17:368. DOI: https://doi.org/10.1016/S1473-3099(17)30126-3

Seyfettinoglu S, Dağoğlu Hark B. HPV vaccinations in males; Knowledge, attitudes, and practices of physicians on human papilloma virus vaccinations for their sons : Physicians’ attitudes on HPV vaccination for their sons. J Surg Med. 2023;7(8):441-5. DOI: https://doi.org/10.28982/josam.7858

Bruni L, Diaz M, Barrionuevo-Rosas L, Herrero R, Bray F, Bosch FX, et al. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. Lancet Glob Health. 2016;4:e453-63. DOI: https://doi.org/10.1016/S2214-109X(16)30099-7

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Published

2023-09-29

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Research Article

How to Cite

1.
Beka H. A retrospective cohort study of human papillomavirus (HPV) genotypes in women with abnormal Pap smear cytology in Turkey: Human papillomavirus (HPV) genotypes with abnormal Pap. J Surg Med [Internet]. 2023 Sep. 29 [cited 2024 Jul. 15];7(9):637-40. Available from: https://jsurgmed.com/article/view/7910