Review of cervical carcinoma screening program in Tamil Nadu, the current trend and recommendations from a histopathologist’s viewpoint

Abstract

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.