Abstract:
Objectives: Human papillomavirus (HPV) is the major etiological agent of cervical cancer, a leading cause of morbidity and mortality in women worldwide; screening strategies for reducing the burden of HPV-mediated carcinogenesis are emerging as effective means for cervical cancer control and prevention in developing countries. Cervical cancer control and prevention strategies are being adopted globally to reduce the disproportionate share of HPV-mediated cervical cancer in the Gardasil vaccine era. My innovative evidence-based exploratory study aimed to identify HPV prevalence and genotype distribution among cervical cancer susceptible women, alongwith Gardasil vaccination awareness for cervical cancer prevention in Asian-Indian women during random population screening in genetically susceptible cohorts of North Indian ethnicity.
Material and methods: Cervical/vaginal exfoliated cells and/or Pap smear specimens were collected from 890 women of North Indian ethnicity residing in Lucknow, Uttar Pradesh and adjoining areas, during random population screening. HPV viral loads in clinical specimens were determined by the Hybrid Capture (hc)-2 HPV DNA assay, and subsequently, positive/negative/borderline HPV status was determined with minimal selection-bias, and considerable specificity and sensitivity. Further, a pilot structured questionnaire-based survey was conducted among a stratified subset of HPV-positive women, with bilingual interviews in either Hindi or English; subsequently the awareness of HPV-mediated cervical cancer and knowledge of Gardasil vaccination was assessed in terms of ‘‘yes’’, ‘‘no’’ and ‘‘no response’’.
Results: HPV prevalence in Asian-Indian women of North Indian ethnicity was 11.7%. HPV genotype distribution was accurately evaluated: 751 out of a total of 890 women (84.4%) participating in HPV screening program were HPV negative (HPV -), 104 (11.7%) tested positive (HPV +) while 35 (3.9%) showed borderline (HPV *) infection status. Furthermore, in the HPV + subjects (N=104), 18 (17.3%) showed strong positivity trends. HPV positivity tends to increase with age in North Indian women; higher the viral load with increasing age, higher is the susceptibility to HPV-mediated cervical cancer. Overall, the response of participants was well-defined, with HPV-mediated cervical cancer awareness in terms of ‘‘yes’’, ‘‘no’’ and ‘‘no response’’ among the study-subjects being 43.7%, 44.7% and 11.6%, respectively. Furthermore, in response to knowledge/awareness of HPV vaccine Gardasil, out of 103 subjects, 28.1% answered ‘‘yes’’ while 37.9% and 34.0% stated ‘‘no’’ and ‘‘no response’’, respectively.
Conclusions: HPV viral load/genotyping may help in identifying women at risk of developing cervical cancer. However, cost-effective HPV screening protocols with a wider population coverage are warranted so as to reduce the burden of cervical cancer in women worldwide in the Gardasil vaccination-era. Therefore, understanding the ecological diversity of HPV prevalence and genotype distribution among genetically susceptible populations in different geographical regions worldwide is essential for optimizing HPV screening, vaccination and maximizing cost-effective public health-oriented strategic efforts for pragmatic evidence-based cervical cancer prevention. Further, bio-specimens viz. HPV-mediated cervical cancer patients’ blood, tissue, DNA, and oocytes may be collected and frozen/stored for long-term usage in individualized pregnancy/family-planning post-cancer chemo-radiotherapy treatment and/or conducting multi-centric public health-gynecologic oncology causal association prevention-epidemiology studies in fertility preservation amongst cervical cancer patients/susceptible women of varying genetic landscapes and socio-cultural exposures.
