Practical Aspects of the Implementation of Screening for the Detection of Malignant Neoplasms of the Cervix during the Medical Examination

Abstract

Relevance. The global strategy for cervical cancer elimination includes the active implementation of primary, secondary and tertiary prevention programs. In the Russian Federation, screening for the detection of malignant neoplasms of the cervix is carried out while women contact specialists, as well as an organized procedure during preventive medical examinations of the certain groups of adults. The study of the population structure of circulating human papillоmavirus (HPV) types, and evaluation of the effectiveness of the recommended diagnostic models will improve the direction of the fight against cervical cancer and introduce optimal preventive solutions. Aim. Retrospective analysis of screening effectiveness for the detection of malignant neoplasms of the cervix, carried out during the medical examination in one institution of Moscow. Materials and methods. The study examined 1068 women aged 20 to 81 years (M = 37.82, Me = 35, IQR 27–47 years) from one institution in Moscow over a 5-year follow-up period (2017–2021). The screening was based on the co-testing model: liquid-based cytology with Papanicolaou staining and classification according to the Bethesda system and quantitative Real Time HPV-test with determination of the 14 HPV DNA types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68). Results. The prevalence of the 14 HPV oncogenic types was 14.87% (95% CI: 12.86–17.13%), the most common were 16 (16.98%), 31 (14.47%), 52 (13.21%). The study determined HPV types with the highest relative risk of persistence: 33, 58, 45, and 52 (p < 0.005). The frequency of HPV detection depended on the age of the examined women and was the highest in the age group of 20–29 years (25.58%). The baseline prevalence was 11.82% (95% CI: 9.98–13.94%). 6 HSIL cases associated with HPV types 16 and 31 were identified. 4/6 were in women under 30 years. The probability of intraepithelial lesions of the cervix increased with an increase of HPV DNA concentration: 23.65% and 66.67% with a viral load of 4.0–6.0 lg copies per 105 human cells and > 6.0 lg copies per 105 human cells, respectively. Conclusions. The study confirmed the great value of HPV- test in screening for the detection of malignant neoplasms of the cervix during the medical examination of the certain groups of adult population, taking into account the advantages of typing and quantitative determination of HPV DNA, as well as the need to consider lowering of the recommended age for the start of HPV-testing.