Mega Hpv laboratories for cervical cancer control: Challenges and recommendations from a case study of Turkey

Abstract

Cervical cancer is the fourth most common cancer among women in the world. It is estimated that one woman dies every 2 min from cervical cancer. Nearly all cervical cancers are preventable by early detection and treatment through screening or HPV vaccination. In 2018, World Health Organization (WHO) made a global call for action toward the elimination of cervical cancer. Cervical cancer screening involves a complex organized program, which begins with a call/recall system based on personal invitation of eligible women, followed by participation in screening, and leading to diagnosis, treatment, and management as appropriate. An effective cervical screening program with high coverage is dependent on each country's infrastructure and human resource capacity. Efforts to develop an effective program is particularly challenging in low and middle income countries (LMIC) where resources are limited. For an effective strategy, Turkey redesigned the country's cervical screening program. The local call/recall system and centralized monitoring system of individual women were re-vamped with an automated evaluation system. The revised screening program includes the use of primary HPV testing with a well-defined protocol outlining the algorithms of management (i.e., screening intervals and referral), a single nationwide centralized diagnostic laboratory, and a sustainable agreement with the HPV diagnostics industry. This system allows for traceable, real-time monitoring of screening visits and specimens. Turkey reports on the first four years of this re-vamped organized program and shares lessons learnt from the implementation of this new program.

Keywords: Cervical cancer; HPV DNA; Mega HPV lab; Screening; Turkey; WHO.

Fig. 1

Flowchart of the National HPV Laboratory. 1a National HPV Lab is on Floor 2 with 7 Rooms, 1b Two barcoded sample from the same patient (conventional cytology and HPV DNA) arrives to the laboratory by Cargo, 1c Barcoding system and software does not allow any mismatch among the millions of samples received 1d Rapid Capture System (RCS) by Qiagen ^® 1e 10 RCS System works simultaneously to detect HPV DNA 1f -1g Cyto-pathologists evaluating the pap Smears in a double blind manner and saving the digital pictures (cyto-gallery) 1h Storage of the positive (5 Years) and negative samples (3 months).