Should Post-Menopausal Women be Screened only with HPV Test in Cervical Cancers?

Abstract

Aim: Target in cervical cancer screenings is to use easy applying, cheap and diagnostic-assisted screening tests together. The most important thing is to do HPV-DNA analysis with Pap smear. The aim in this study is to perform a detailed follow-up program according to the results of patients who had been diagnosed with cervical intraepithelial lesion (SIL) who applied to the hospital for 2 years and to find out whether being used HPV-DNA results affected the SIL lesions without applying a smear test (pap test) in the menopausal patients with negative HPV-DNA analysis by performing only HPVDNA analysis. Materials and Methods: A smear test was requested for 11,850 patients aged 50 ± 3.2 in the Zekai Tahir Burak Women’s Health Training and Research Hospital between the years 2015-2016 for a 2-year period. 5180 patients are menopausal. HPV-DNA genotyping analyzes were performed for HPV 16,18,31,33,35,3 9,45,51,56,58,66 and 68 types while 1102 of these patients were followed by pap test for Low grade SIL, and colposcopies were performed and biopsies were taken by the same gynecologist. In this study, Chi-square test, Mann Whitney U test were used for the statistical analysis and Spearman Rho test was used for correlation analysis with IBM SPSS statistical program version 21.0. Values of p ≤ 0.001 were considered significant. Non-significant analyzes were not used in this study. In the result of histopathological examination, cases were compared with smear findings. For colposcopy, Barcelona 2002 colposcopy terminology was used. In the histopathologic analysis of colposcopic biopsies, Bethesda System 2014 version and also HPV ascia LAST in ano-genital lesion coexistence were used for classification. Findings: Patients were selected among 11,850 patients who applied to the hospital between 2015 and 2016 and were received cervical cytology specimens. 5180 patients were in menopausal period. 1102 of these patients have LSIL. 278 of the LSIL 1102 patients were reported as HPV (+) CIN I neoplasia and the remaining 824 patients as HPV (-) non-neoplastic lesion. CIN I lesion in 270 patients and CIN II lesion in 8 were determined with colposcopic biopsy performed in HPV-DNA (+) group (n=278). CIN I lesion in 670 patients and CIN II in 14 patients were also found with colposcopic biopsy performed in HPV-DNA (-) group (n=840); in 140 patients dysplasia was not observed. We think that only HPV-DNA analysis is not appropriate for menopausal HPV (+), pap smear negative patients with negative