To describe the first round of cervical cancer screening in the Barbastro area, where co-testing was conducted, and to study the effectivity and sensitivity of the HPV-DNA testing.
CIN2+ cases diagnosed between January 1st, 2011 to December 31st, 2015 and follow-up until January 31st, 2016; were described. The target population was 24,501 women between 30 to 64 years. Patients came from primary care screening and gynaecological consultations. We screened with hrHPV DNA testing and cytology according to SEGO 2010 protocols, which recommend screening with co-testing every 5 years.
HC2® (Qiagen) was the assay used during the first 10 months giving positive or negative results. Cobas® 4800 (Roche) was used during the remaining period giving the genotype for HPV 16, 18 and the pool of 12 hrHPV (31, 33, 35, 39, 45, 51 52 56, 58, 59, 66 y 68).
Loop electrosurgical procedure (LEEP) was the first choice to treat cervical intraepithelial neoplasia (CIN). Repeated conisation and hysterectomy with or without anexectomy followed initial treatment when necessary. Co-testing at 6 months and follow-up with HPV-DNA testing y/or cytology at 12 and 24 months were recommended.
A total of 238 women with an age average of 37.9±10.3 participated in the clinical program; 162 (68.1%) were born in Spain and 65 (27.3%) overseas. 37 women (15.5%) had follow-up after having positive HPV test with negative cytology results. 57 (25.4%) patients were positive for HPV 16, 7 (3.1%) for HPV 18, and 74 (33.0%) tested positive for the pool of hrHPV. 4 (1.8%) women tested negative: 2 women presented a CIN2/3 and 2 presented invasive carcinoma (one adenocarcinoma and one squamous carcinoma) with Quiagen and/or Roche test. Sensitivity was 77.9% and 98.7% for Cytology and HPV testing, respectively.
18 women had invasive carcinomas, 7 of which were microinvasive (38,9%). Out of the 220 CIN cases, 37 (15.5%) were CIN2 and 183 (76.9%) were CIN3. The horizontal extension of CIN was less than 1mm in 27 (21.3%). Clear margins after LEEP were obtained in 171 (84.2%) patients. Reoperation was necessary because of residual disease in 8 CIN (3.4%), and all microinvasive carcinomas.
At first post-treatment control, 133 patients (77.3%) were negative for HPV. Positive HPV results persisted in 22 patients (12.6%). A correlation with been born overseas (p:0.008), positive margins (p:0.023) and horizontal extension less than 1 mm (p:0.036) was detected.
Efficiency of co-testing is shown in our area. Persistent HPV positive results after CIN treatment are very low and are associated with been born overseas, positive margins and very focal extensions, suggesting the last a multifocal affectation.