Cervical Cancer and its Association with Human Papilloma Virus (HPV) Genotypes in Khartoum State. Screening Study

Abstract

This study was carried out in Khartoum State during a period from July 2007 to July 2009. This research aimed to screen the cervical cancer among women in Khartoum State using Papanicolaou (Pap) stain and to detect and identify human papilloma virus (HPV) different genotypes. Four hundred samples were taken from patients who attended different hospitals in Khartoum State; Khartoum Hospital, Khartoum- North Hospital (Bahri) and Al Neelain Clinic Center. The specimens were processed and examined under the light microscope for pap.stain and H&E (in six patients who were subjected to histopathological examination) and for HPV detection; Jacobs procedure was used, and the instruction of the manufacturer was followed in genotypes identification. The pre-cancer cells were detected in 30(7.5%) samples, as follows: mild dyskaryosis was present in 18 (4.5%), moderate dyskaryosis in 5(1.3%), severe dyskaryosis 6 (1.5%) patients. HPV infection was found in 6 (1.5%) patients, who had mild dyskaryosis, Trichomonus.vaginalis was present in 8 (2.0%)cases, only 1(.3%) with dyskaryosis. Other infectious agents were also observed such as Candida.spp (the most accounted), Actinomyces.spp, GonoCocci spp, Aspergillus fumigatus and Monilia. From 6 women, who were subjected to histopathological examination ,one (0.3%) appeared to have poorly differentiated squamous cell carcinoma, 3 (0.8%) moderately differentiated squamous cell and 2 (0.5%), a well differentiated squamous cell carcinoma. HPV was detected in 144 (36.0%) samples. Single HPV infection was detected in 37.2% of positive HPV women. Multiple infection(infection by more than one HPV type) was observed in 50.3%) of patients and positive HPV for other genotypes (other than the 14 types demonstrated) in 12.5%, the high risk HPV was higher (84.9%) than low risk HPV (0.7%) and mixed infection(high and low risk HPV) were found in (4.9%) of patients. The high risk HPV subtypes mostly encountered are HPV 16 detected in 49 (34.0%) cases, followed by HPV 39 (41, 28.5%), HPV 35 (26 ,18.0%), HPV 59 ( 20, 13.9%) , HPV 56 (18, 12.5%), HPV 58 (14, 9.7%), HPV 18 (10, 6.9%), HPV 66 (9, 6.2%), 52 ( 6, 4.2%), HPV 45 (5, 3.5%), HPV 33 (4, 2.8%), HPV 31 (4, 2.8%) and the low risk (6,11), HPV 11were found in 7 (4.9%) and HPV 6 in 4 (2.8%), cases, and 18 (12.5%) positive of other types. The HPV subtypes detected in association with cytological changes, include, HPV 16 which was detected in 4(13.3%) of the 30 patients , HPV 18 in 2(6.7%), HPV 58 in 1(3.3%), HPV 56 in 2(6.7%), HPV 35 in 1(3.3%), HPV 16,18 in 2(6.7%), HPV16,35 in 4(13.3%), HPV 31,16 in 1(3.3%), HPV16,39 in 3( 10%), HPV 16,39,56 in 1(3.3%), HPV16,56 in 2(6.7%), HPV 45 in 2(6.7%), HPV 45, 35,39 in 1(3.3%) , HPV 39,59,56 in 1(3.3%), HPV 35,11 in 1(3.3%), HPV of un known types(other than 14 types) in 1(3.3%)patients. The study concluded that the prevalence of HPV infection is high in Sudanese women. The prevalence of HPV was 36%, in pre-cancer cases (96.6%), and (83.3%) in cervical cancer patients. The high risk HPV is greater than low risk, with high account of multiple HPV genotypes infections. HPV 16 was genotypemostly detected (34%) and always in association with cervical interaepithelial neoplasia (CIN) in young women and women with cervical squamous carcinoma. Although the highest HPV prevalence was detected in women aged 30-39 , high HPV prevalence were also found in age group 15-20 year and in patients more than 50 year old. According to Sudanese different tribes, the high prevalence of pre-cancer and cancer cells, and HPV occurrence were present in central Sudan tribes, western tribes, and northern tribes. Screening of cervical cancer by HPV detection was found to be more effective than screening by cytological examination (Pap. technique) to detect women at risk. The education, uses of contraceptives, and intra uterine contraceptive devices (IUCD), did not appear to influence the risk factor. High statistically was significantly associated to occurrence of both, HPV (P value 0.027) and cytological changes (P value 0.011).