Cervical cancer incidence and mortality are low in Iran but the prevalence of HPV infection is increasing. On the other hand, there is no national population based program for screening of cervical cancer in Iran and a large number of women did Pap smear test based on the gynecologist prescription even annually and with different interval and inadequate accuracy. Ministry of Health of Iran planned a National cervical cancer early detection and screening Program from 2017.
Women aged 30-69 called to health care service centers in the first phase in four cities and were evaluated using cytology and HPV DNA test assays in cervical samples. In the next phase and based on new evidence and expert panel recommendation the age range of program decreased to 30-49. All samples were sent to a national lab we prepared for this purpose in Tehran. HPV DNA test was accomplished recruiting automated devices for purification, master mix preparation and electrophoresis steps. The viral DNA was amplified by conventional polymerase chain reaction using the PGMY09/11 set of primers. Experimental validation was performed for HPV DNA test according to the WHO HPV laboratory guidelines. Standard HPV plasmid of different genotypes and human cervical cancer cell lines (Hela and Ca-ski) was used to determine the analytical sensitivity of the assay. Real time PCR was used to assess the type-specific prevalence of high risk (HR)-HPV genotypes; HPV-16 and HPV-18 as predominant associated agents of cervical cancer.
Among 20,000 cases tested from April 2017 in four cities, around 1400 cases were detected positive for HPV infection of any genotype using PCR-based HPV test, which is account for 7% of HPV infection prevalence. At the time of preparation of this manuscript the result of genotyping is not ready but We scheduled to do assay for 1000 cases daily so the presented results will update for the presentation we can present the result of more samples from more cities and genotyping in October.
We have just launched a national cervical cancer screening program with HPV testing and Cytology in Iran as the vast member in Middle East. We plan to up scale the program whole country step by step and with more automated method that help us prevent cervical cancer occurrence and decrease its mortality.