Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 11 , ISSUE 6 ( November-December, 2019 ) > List of Articles

Original Article

Review of Cervical Carcinoma Screening Program in Tamil Nadu, the Current Trend and Recommendations from a Histopathologist’s Viewpoint

Shifa S Ibrahim, Kamaleshwari Kesavaraj, Muthumani Arun, Syed AM Ameen, Raasi Sankar

Keywords : Acetowhite, Dysplasia, Human papillomavirus, Vaccine

Citation Information : Ibrahim SS, Kesavaraj K, Arun M, Ameen SA, Sankar R. Review of Cervical Carcinoma Screening Program in Tamil Nadu, the Current Trend and Recommendations from a Histopathologist’s Viewpoint. J South Asian Feder Obs Gynae 2019; 11 (6):356-362.

DOI: 10.5005/jp-journals-10006-1735

License: CC BY-NC 4.0

Published Online: 25-02-2013

Copyright Statement:  Copyright © 2019; The Author(s).


Objective: Cervical carcinoma, the commonest carcinoma affecting Indian females, is caused by human papillomavirus (HPV) infection. Primordial prevention and primary prevention with HPV vaccine and cancer screening, respectively, can go a long way in preventing this carcinoma. The health system project in Tamil Nadu has done a commendable job in reducing the disease burden by introducing screening program for cervical carcinoma at the grassroots level way back in 2005. This study was done to evaluate the cervical biopsy specimens received as a part of this program to compute its incidence, compare the incidence among various districts, and suggest future directions based on our observations. Materials and methods: From the visual inspection with acetic acid (VIA)/visual inspection with Lugols iodine (VILI) positive cervical biopsy specimens, 506 were chosen randomly from various districts. Based on histopathological examination, incidence of individual lesions and district-wise incidence were calculated. Predictive factors that determine the progression of these lesions were analyzed based on the literatures. Results: Out of the 506 cervical biopsy specimens, 34 were unsatisfactory. The incidence of high-grade dysplasia peaked around 31–40 years and squamous cell carcinoma peaked among 51–60 years. Madurai ranked high in the incidence of both high-grade dysplasia and carcinoma. Conclusion: Incidence of dysplasia and carcinoma in our study was comparable with that seen in the literatures. Integration of HPV DNA studies into the program can increase the detection rate, detect the progressors, and helps in identifying the HPV species prevalent in an area and formulating cost-effective HPV vaccine cocktail.

  1. Indian Council of Medical Research. National cancer registry programme, twoyear report of the hospital based cancer registries 19992000. Bangalore: ICMR. 2005: 3. .
  2. Moreno V, Bosch FX, Munoz N, et al. Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: The IARC multicentric case.control study. Lancet 2002;359(9312):1085.1092. DOI: 10.1016/S0140-6736(02)08150-3.
  3. Koskela P, Anttila T, Bjorge T, et al. Chlamydia trachomatis infection as a risk factor for invasive cervical cancer. Int J Cancer 2000;85(1):35.39. DOI: 10.1002/(SICI)1097-0215(20000101)85:1<35::AID-IJC6>3.0.CO;2-A.
  4. Sowjanya AP, Jain M, Poli UR, et al. Prevalence and distribution of high-risk human papilloma virus (HPV) types in invasive squamous cell carcinoma of the cervix and in normal women in Andhra Pradesh, India. BMC Infect Dis 2005;5:116. DOI: 10.1186/1471-2334-5-116.
  5. Kovacic MB, Castle PE, Herrero R, et al. Relationships of human papillomavirus type. Qualitative viral load, and age with cytologic abnormality. Cancer Res 2006;66:10112.10119. DOI: 10.1158/0008- 5472.CAN-06-1812.
  6. Lorincz AT, Reid R, Jenson AB, et al. Human papillomavirus infection of the cervix: relative risk associations of 15 common anogenital types. Obstet Gynecol 1992;79(3):328.337. DOI: 10.1097/00006250- 199203000-00002.
  7. Poli UR, Bidinger PD, Gowrishankar S. Visual Inspection with Acetic Acid (VIA) Screening Program: 7 Yearsf experience in early detection of cervical cancer and pre-cancers in rural south India. Indian J Community Med 2015;40(3):203.207. DOI: 10.4103/0970-0218.158873.
  8. Sankaranarayanan R, Rajkumar R, Theresa R, et al. Initial results from a randomized trial of cervical visual screening in rural south India. Int. J. Cancer 2004;109(3):461.467. DOI: 10.1002/ijc.11726.
  9. Ghosh P, Gandhi G, Kochhar PK, et al. Visual inspection of cervix with Lugolfs iodine for early detection of premalignant & malignant lesions of cervix. Indian J Med Res 2012;136(2):265.271.
  10. Blomberg M, Friis S, Munk C, et al. Genital warts and risk of cancer: a Danish study of nearly 50000 patients with genital warts. J Infect Dis 2012;205(10):1544.1553. DOI: 10.1093/infdis/jis228.
  11. Koss LG, Durfee GR. Unusual patterns of squamous epithelium of the uterine cervix: cytologic and pathologic study of koilocytic atypia. Ann NY Acad Sci 1956;63:1245.1261. DOI: 10.1111/j.1749-6632.1956. tb32134.x.
  12. Meisels A, Fortin R. Condylomatous lesions of the cervix and vagina.1. Cytotogical patterns. Acta Cytol 1976;20(6):505.509.
  13. Luthra UK, Prabhakar AK, Seth P, et al. Natural history of precancerous and early cancerous lesions of the uterine cervix. Acta Cytol 1987;31(3):226.234.
  14. Bhaskaran CS, Bhagyalakshmi M, Rani LU. Premalignant and malignant lesions of cervix. Indian J Med Res 1978;67:97.105.
  15. Cox JT, Schiffman M, Solomon D, et al. Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy. Am J Obstet Gynecol 2003;188(6):1406.1412. DOI: 10.1067/mob.2003.461.
  16. Sankaranarayanan R, Basu P, Wesley R, et al. Accuracy of visual screening for cervical neoplasia: results from an IARC multicentre study in India and Africa. Int J Cancer 2004;110(6):907.913. DOI: 10.1002/ijc.20190.
  17. Basu PS, Sankaranarayanan R, Mandal R, et al. Visual inspection with acetic acid and cytology in the early detection of cervical neoplasia in Kolkata, India. Int J Gynecol Cancer 2003;13:626.632. DOI: 10.1136/ ijgc-00009577-200309000-00009.
  18. Patnick J. Cervical cancer screening programme 2000. Reducing the risk. NHS Cervical cancer screening programme. National Health Service, Sheffield, UK 2000.
  19. Australian Institute of Health and Welfare. Cervical cancer screening in Australia 1997.1998. AIHW Cat No 9. Canberra: Australian Institute of Health and Welfare; 2000.
  20. Nasiell K, Roger V, Nasiell M. Behaviour of mild cervical dysplasia during long-term follow-up. Obstet Gynecol 1986;67(5):665.669. DOI: 10.1097/00006250-198605000-00012.
  21. Nasiell K, Nasiell M, Vaclavinkova V. Behaviour of moderate cervical dysplasia during long-term follow-up. Obstet Gynecol 1983;61(5):609.614.
  22. Disease Specific Documents for XII plan. Human Papilloma Virus ICMR: High power Committee to Evaluate Performance of ICMR, 2012.2013. New Delhi, India: ICMR; 2014.
  23. Hildescheim A, Schiffman MH, Gravit PE, et al. Persistence of type specific human pappiloma virus infections among cytologically normal women. J Infect Dis 1996;174:927.936. DOI: 10.1093/ infdis/174.5.927.
  24. Tidbury P, Singer A, Jenkins D. CIN 3: the role of lesion size in invasion. Br J Obstet Gynaecol 1992;99(7):583.586. DOI: 10.1111/j.1471- 0528.1992.tb13825.x.
  25. Koeneman MM, van Lint FHM, van Kuijk SMJ, et al. A prediction model for spontaneous regression of cervical intraepithelial neoplasia grade 2, based on simple clinical parameters. Hum Pathol 2017;59:62.69. DOI: 10.1016/j.humpath.2016.09.012.
  26. Velez-Perez A, Wang XI, Li M, et al. SIRT1 overexpression in cervical squamous intraepithelial lesions and invasive squamous cell carcinoma. Hum Pathol 2017;59:102–107. DOI: 10.1016/j.humpath.2016.09.019.
  27. Greer BE, Figge DC, Tamimi HK, et al. Stage IB adenocarcinoma of the cervix treated by radical hysterectomy and pelvic lymph node dissection. Am J Obstet Gynecol 1989;160(6):1509–1514. DOI: 10.1016/0002-9378(89)90877-6.
  28. Goldie SJ, Gaf fkin L, Goldhaber-Fieber t JD, et al. Costeffectiveness of cervical cancer screening in fve developing countries. N Engl J Med 2005;353(20):2158–2168. DOI: 10.1056/ NEJMsa044278.
  29. Stoler MH, Ronnett BM, Joste NE, et al. The Interpretive variability of cervical biopsies and its relationship to HPV status. Am J Surg Pathol 2015;39(6):729–736. DOI: 10.1097/PAS.0000000000000381.
  30. Bhatla N, Lal N, Bao YP, et al. A meta-analysis of human papillomavirus type-distribution in women from South Asia: implications for vaccination. Vaccine 2008;26(23):2811–2817. DOI: 10.1016/ j.vaccine.2008.03.047.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.