HPV co-testing as cervical screening test, Experience of Alweiya early detection cervical clinic: one-year Analysis

  • Zainab J Al-Jobawi Cancer screening fellowship, Babil Health Directorate, Ministry of Health, Iraq.
  • Besmah M. Ali Gazi Al Hariri hospital, Ministry of Health, Baghdad, Iraq.
  • Asan A Al-Niyazee AL-Alwiyaa maternity teaching hospital, Ministry of Health, Baghdad, Iraq.
  • Mustafa H Ibraheem AL-Alwiyaa maternity teaching hospital, Ministry of Health, Baghdad, Iraq.


Objectives: The high-risk Human papilloma virus test with conventional cytology (HPVco-test) was firstly introduced in our institute at May 2019 so we aimed to estimate the prevalence of abnormal cytology and positive high-risk human papillomavirus test results in a screening woman and to assess the accuracy between cytology and Human papilloma virus testing to evaluate the feasibility of integrating the latter as a primary test in the national cervical cancer screening program.
Methods: A prospective study for women attending to early detection cervical clinic, during the period from May 2019 to May 2020. Patients who were sexually active were included in the study. Samples for conventional cytology and HPV by using real-time polymerase chain reaction technique for high risk types were taken concurrently. The prevalence of positive screening results and the difference in accuracy between two testing were estimated by McNemar’s χ2 test.
Result: A total of 388 women were included in the study. The prevalence of positive test for hr-HPV was 2.1%(8) while the prevalence of abnormal cytology test was 19.1%(74), Concerning discordant pairs, 0.8%(3) of women had normal cytology with a positive hr-HPV test result and 17.8%(69) of women had abnormal cytology with a negative  hr-HPV test result. A total of 311 (80.1%) women had normal cytology and negative hr-HPV test results. The proportion of women with abnormal cytology and positive hr-HPV test results was 1.3% (5 women). the difference in accuracy between the two results was statistically significant (<0.0001). The prevalence of positive hr-HPV test decreased with increasing age, whereas the prevalence of abnormal cytology showed a bimodal age pattern.
Conclusion: The prevalence of abnormal cytology was high to that of hr-HPV testing, which could not allow for the implementation of hr-HPV as a primary test in the national screening program in Iraq.
share this Article by


1. Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. The Lancet Global Health. 2020;8(2):e191-e203.
2. Board IC. Annual report of cancer disease in Iraq 2013. In: Board C, editor.: Ministry of Health; 2017.
3. Ghittoni R, Accardi R, Chiocca S, Tommasino M. Role of human papillomaviruses in carcinogenesis. Ecancermedicalscience. 2015;9.
4. Papillomaviruses H. IARC monographs on the evaluation of carcinogenic risks to humans. Lyon, France: IARC. 2011.
5. Thun M, Linet MS, Cerhan JR, Haiman CA, Schottenfeld D. Cancer epidemiology and prevention: Oxford University Press; 2017.
6. de Kok IM, van der Aa MA, van Ballegooijen M, Siesling S, Karim‐Kos HE, van Kemenade FJ, et al. Trends in cervical cancer in the Netherlands until 2007: has the bottom been reached? International journal of cancer. 2011;128(9):2174-81.
7. Arbyn M, Ronco G, Anttila A, Meijer CJ, Poljak M, Ogilvie G, et al. Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine. 2012;30:F88-F99.
8. Ronco G, Dillner J, Elfström KM, Tunesi S, Snijders PJ, Arbyn M, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. The lancet. 2014;383(9916):524-32.
9. Ogilvie GS, van Niekerk D, Krajden M, Smith LW, Cook D, Gondara L, et al. Effect of screening with primary cervical HPV testing vs cytology testing on high-grade cervical intraepithelial neoplasia at 48 months: the HPV FOCAL randomized clinical trial. Jama. 2018;320(1):43-52.
10. Smith RA, Andrews KS, Brooks D, Fedewa SA, Manassaram‐Baptiste D, Saslow D, et al. Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening. CA: a cancer journal for clinicians. 2019;69(3):184-210.
11. von Karsa L, Arbyn M, De Vuyst H, Dillner J, Dillner L, Franceschi S, et al. European guidelines for quality assurance in cervical cancer screening. Summary of the supplements on HPV screening and vaccination. Papillomavirus Research. 2015;1:22-31.
12. Wright Jr TC, Schiffman M. Adding a test for human papillomavirus DNA to cervical-cancer screening. New England Journal of Medicine. 2003;348(6):489-90.
13. Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. Jama. 2018;320(7):674-86.
14. Elfström KM, Arnheim-Dahlström L, von Karsa L, Dillner J. Cervical cancer screening in Europe: quality assurance and organisation of programmes. European Journal of Cancer. 2015;51(8):950-68.
15. Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, Prey M, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. Jama. 2002;287(16):2114-9.
16. Suteu O, Blaga ML, Nygård M, Leinonen MK, Nicula F, Pais R, et al. Prevalence of positive screening test results and agreement between cytology and human papillomavirus testing in primary cervical cancer screening in North-Western Romania. European Journal of Cancer Prevention. 2020;29(2):141-8.
17. ÇaliŞkan E, CoŞkun SK, ÖztÜrk CE, CangÜr Ş, Önal B. Analysis of HPV genotypes and liquid-based cervical cytology: Results from a tertiary academic center in northwestern Turkey. Japanese Journal of Infectious Diseases. 2020:JJID. 2020.072.
18. Tahir QA, Bukhari MH. Evaluation of pre-malignant cervical lesions in females presenting with abnormal pelvic complaints. JPMA The Journal of the Pakistan Medical Association. 2020;70(2):272-5.
19. Nayak PK, Mitra S, Agrawal S, Hussain N, Thakur P, Mishra B. Role of various screening techniques in detecting preinvasive lesions of the cervix among symptomatic women and women having unhealthy cervix. 2020.
20. Gravitt PE, Paul P, Katki HA, Vendantham H, Ramakrishna G, Sudula M, et al. Effectiveness of VIA, Pap, and HPV DNA testing in a cervical cancer screening program in a peri-urban community in Andhra Pradesh, India. PloS one. 2010;5(10):e13711.
21. Kim M-J, Kim JJ, Kim S. Type-specific prevalence of high-risk human papillomavirus by cervical cytology and age: Data from the health check-ups of 7,014 Korean women. Obstetrics & gynecology science. 2013;56(2):110-20.
22. Castle PE, Fetterman B. Five-year experience of human papillomavirus DNA and Papanicolaou test cotesting. Obstetrics and gynecology. 2009;113(3):595.
23. Wright Jr TC, Stoler MH, Behrens CM, Apple R, Derion T, Wright TL. The ATHENA human papillomavirus study: design, methods, and baseline results. American journal of obstetrics and gynecology. 2012;206(1):46. e1-. e11.
24. Vardell E. Global Health Observatory Data Repository. Medical Reference Services Quarterly. 2020;39(1):67-74.
25. Monsonego J, Cox JT, Behrens C, Sandri M, Franco EL, Yap P-S, et al. Prevalence of high-risk human papilloma virus genotypes and associated risk of cervical precancerous lesions in a large US screening population: data from the ATHENA trial. Gynecologic oncology. 2015;137(1):47-54.
26. Kitchener H. HPV primary cervical screening: time for a change. 2015.
27. Bruni L, Diaz M, Castellsagué M, Ferrer E, Bosch FX, de Sanjosé S. Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. Journal of Infectious Diseases. 2010;202(12):1789-99.
28. Forman D, de Martel C, Lacey CJ, Soerjomataram I, Lortet-Tieulent J, Bruni L, et al. Global burden of human papillomavirus and related diseases. Vaccine. 2012;30:F12-F23.
29. Tachezy R, Smahelova J, Kaspirkova J, Salakova M. Human papillomavirus type-specific prevalence in the cervical cancer screening population of Czech women. PLoS One. 2013;8(11):e79156.
30. Bao Y-P, Li N, Smith J, Qiao Y-L. Human papillomavirus type distribution in women from Asia: a meta-analysis. International Journal of Gynecologic Cancer. 2008;18(1).
31. Ciotti M, Sesti F, Paba P, Benedetto A, Patrizi L, Criscuolo A, et al. Human papillomavirus (HPV) testing in the management of women with abnormal Pap smears. Experience of a colposcopy referral clinic. European journal of gynaecological oncology. 2004;25(5):577-84.
32. Gonzalez-Bosquet E, Almagro MM, Mora I, Suñol M, Callejo J, Lailla J. Prevalence of human papilloma virus infection of the uterine cervix in women with abnormal cervical cytology. European journal of gynaecological oncology. 2006;27(2):135-8.
33. Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors. Journal of lower genital tract disease. 2020;24(2):102.
34. Wright Jr TC, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. American journal of obstetrics and gynecology. 2007;197(4):346-55.
How to Cite
AL-JOBAWI, Zainab J et al. HPV co-testing as cervical screening test, Experience of Alweiya early detection cervical clinic: one-year Analysis. Journal of Contemporary Medical Sciences, [S.l.], v. 6, n. 5, oct. 2020. ISSN 2413-0516. Available at: <http://www.jocms.org/index.php/jcms/article/view/859>. Date accessed: 25 nov. 2020. doi: https://doi.org/10.22317/jcms.v6i5.859.