Vijayalakshmi, P (2010) Prevalence of high risk human papilloma virus in symptomatic women attending our gynaecology OPD. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Invasive cancer of cervix is considered as a preventable disease because it has a long preinvasive state, cervical cytology screening programs are currently available and the treatment of preinvasive lesions is effective. Normally the lifetime probability for developing cervical cancer is 1:128.Although screening programs in US are well established, it is estimated that 30% of cervical cancer cases will occur in women who have never had a PAP test. In developing countries, this percentage approaches sixty. Human Papilloma Virus is the major aetiological agent for cervical cancer, the second common cancer among the women everywhere in the world (Munoz et al 1994). This virus is also implicated in other anogenital cancers. HPV is among the most important viruses in causation of cancer. A large number of epidemiological, biological and chemical studies are underway to get to know the nature of this infection and its outcome. The prospects of HPV vaccine in preventing cervical cancer make it the most suitable target for studies in low resource settings with high morbidity and mortality from cervical cancer. Cervical cancer is the second most common cancer among women worldwide. The majority of the cases occur in the developing world, where in most countries, it is the leading cause of cancer mortality in women. An estimated 470,000 new cases of cancer cervix are diagnosed each year worldwide and 80% of these occur in the developing world. A quarter of the global burden is experienced in India, where about 126,000 new cases and 71000 deaths attributable to cervical cancer are estimated to occur each year. Cancer cervix constitutes15-51% of all female cancers and rates of age-standardised incidence range from 17.5 to 55% per 100,000 women in different regions of India. More than 80% are diagnosed at an advanced clinical stage and 5 year survival is less than 40%. In many developed countries a decline in the incidence and mortality caused by cervical cancer has been observed in the past 30 years as a result of screening by cytology. India has the burden of having the largest number of women with cervical cancer contributing to18% of world’s total number. One out of every 5 women in world suffering from cervical cancer is from India. AIM OF THE STUDY: The aim of the study is to determine the prevalence of high risk human papilloma viruses 16 and 18 in women with symptoms of chronic discharge per vaginum and those with cancer cervix attending our Gynaecology OPD. MATERIALS AND METHODOLGY: The study was conducted at the Institute of Obstetrics and Gynaecology, Egmore in collaboration with the Department of Biotechnology, Cancer Biology Lab, IIT, Chennai between 2008-2009. Study Design and Population: It is a hospital based study .300 Consenting women attending the Gynaecology OPD at our Institute were enrolled with 100 cases belonging to the symptomatic group and 100 belonging to cancer cervix and 100 cases who came to the OPD for other complaints. Inclusion Criteria: The women with the following criteria were included in the symptomatic group in our study 1. Age 16 to 70 years, 2. Patients with complaints of persistent vaginal discharge, 3. Patients with complaints of intermenstrual or postcoital bleeding, 4. Unhealthy cervix per speculum. Simultaneously 100 women with frank carcinoma cervix and 100 women who attended the Gynaecology OPD for other complaints who underwent total Hysterectomy due to complaints other than uterine cervical lesions such as uterine fibroid, endometriosis and so on were also studied for HPV prevalence. Exclusion Criteria: The women fulfilling the following criteria were excluded from the study 1. Pregnant women and puerperium, 2. Women with bleeding at the time of examination, 3. Clinical evidence of acute infection, 4. Unsatisfactory colposcopy, 5. Unmarried women, 6. Women undergoing radiotherapy or chemotherapy for cancer cervix, 7. Women with cancer cervix recurrence. Consent and Ethical Considerations: A written informed consent in local vernacular was obtained from each patient prior to enrolment in the study .Ethics Committee of the Institution approved the study protocol. METHODOLOGY: Relevant socioeconomic, obstetric, gynaecological, and medical history was obtained in a pretested, semi structured questionnaire. SUMMARY: This study was conducted in our Institute which comprises women attending the Gynaecology OPD for various reasons. 300 consenting women were enrolled with 100 belonging to the group of women who came with complaints of persistent vaginal discharge, 100 women who came for other complaints and 100 women with frank cancer cervix. A Pap smear was obtained in the index study and colposcopic guided biopsy of the cervical tissues was also obtained. Cervical tissue samples in subjects who underwent total hysterectomy due to complaints other than uterine cervical lesions such as uterine fibroids, endometriosis and so on, were obtained from theatres posted for fractional curettage after verifying the basic screening report .Cervical punch biopsy samples were taken in 100 women who came with frank cancer cervix. Cervical tissue samples were stored and Reverse Transcriptase Polymerase chain reaction (RT-PCR) was done to assay HPV DNA16 and 18. The prevalence of HPV 16 and 18 in each of the groups was analysed. We found that the prevalence of HPV 16 in the index study, in women with other symptoms and those with cancer cervix was 63%, 15%, and 97% respectively. HPV 18 prevalence in cancer cervix was 32%.HPV 16 prevalence was highest in the age group 30 – 40 years It was also high in women who got married at an early age, women belonging to the lower socioeconomic strata, and in the illiterate group. We did not observe any significant parity related difference in HPV 16 prevalence. The index study generated the prevalence data of subclinical high risk HPV infection in the symptomatic women. The limitation of the study is that being a hospital based study, the women enrolled visited the hospital with varied ailments and thus were not true representations of the community. In addition, the prevalence of high risk HPV, other than hpv 16 AND 18 was not evaluated. Cancer cervix screening practices are inconsistent in India. Use of Pap smear, as a sole indicator for screening has limitations. The cytological interpretation becomes faulty if the smear is inflammatory, a situation not infrequent among women from the lower socioeconomic background. In a scenario of infrequent screening, screening with a test of high sensitivity provides greater reassurance, that potential disease has not been missed in women who screened negative. It is an irony that the middle and high socioeconomic women, who can afford HPV screening by molecular techniques require it the least, owing to the low prevalence. High risk HPV DNA screening appears to be a valid option in mass cervical screening programmes in the developed countries. In a resource poor country, it is not feasible to offer a universal molecular testing for high risk HPV, till HPV screening is made cheaper. Identification of population at risk will enable focused screening, with a greater cost effective utilization of resources. Screening preferentially should be directed to the target population for the optimal utilization of resources. Needless to say, health education, promotion of condom usage, and need to follow healthy hygienic practices is the most cost effective approach in reducing the incidence of cervical carcinoma in resource-crunched societies.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Prevalence, high risk human papilloma virus, symptomatic women, Gynaecology OPD. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Nov 2017 12:32 |
| Last Modified: | 05 Oct 2019 02:11 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4104 |
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