Introduction

Cervical cancer ranked second among most commonly diagnosed cancer and in less developed countries it is third leading cause of cancer related death among females^1,2,3 Cancer cervix is a multifactorial disease. Major risk factors are age^4,5, illiteracy, low socioeconomic status, early menarche, marital status, early marriage, early first childbirth, age at last child birth, multiparity, abortion, multiple sexual partners, late menopause, genital infection, poor genital hygiene, tobacco use, passive smoking and contraceptive use ^6-10. Other risk factors includes co-infection with Chlamydia trachomatis, non-use of condoms by partners and nutritional factors.^11-16

Human Papilloma virus (HPV) infection is the most important risk factor. ¹⁷ It has been shown recently that cervical cancer is strongly associated with the presence of high risk or oncogenic Human Papilloma virus (HPV) types (up to 100%).^18,19 it is the expression of viral oncogenes E6 /E7 which is  prerequisite for progression toward malignancy and maintenance of the cancerous phenotype^20,21. As the severity of the lesion increases levels of E6/E7 also rises.^22,23 E6 and E7 transcripts could be useful as markers of disease progression.²²

Aims and Objectives

This study is carried out to correlate impact of socioeconomic status on occurrence of epithelial cell abnormality reported on cervical Pap smear study using 2014 Bethesda System and flow cytometry detection of HPV mRNA expression in present scenario.

1. Lindsey A. Torre; Freddie Bray; Rebecca L. Siegel; Jacques Ferlay; JoannieLortet-Tieulent; AhmedinJemal. Global Cancer Statistics, 2012. CA CANCER J CLIN 2015;65:87–108: 99-100.
2. Bojgua S; Kldiashvili E. Liquid Based Cytology Cervical Cancer Screening Program – Georgian Experience. Arch Can Res. 2016, 4: 3.
3. Ekane, G.E.H et al. (2015) Pap smear Screening, the Way Forward for Prevention of Cervical Cancer? A Community Based Study in the Buea Health District, Cameroon. Open Journal of Obstetrics and Gynecology, 5, 226-233.
4. Sánchez-Anguiano LF, Alvarado-Esquivel C, Reyes-Romero MA, Carrera- Rodríguez M. Human papilloma virus infections in women seeking cervical Papanicolaou cytology of Durango, Mexico: Prevalence and genotype. BMC Infec Dis 2006;6:27-33.
5. García-Piñeres AJ, Hildesheim A, Herrero R, Trivett M, Williams M, Atmetlla I, et al. Persistent human papillomavirus infection is associated with a generalized decrease in immune responsiveness in older women. Cancer Res 2006;66:11070-6.
6. Patil V, Wahab SN, Zodpey S, Vasudeo ND. Development and validation of risk scoring system for prediction of cancer cervix. Indian J Public Health 2006;50:38-42.
7. Juneja A, Sehgal A, Mitra AB, Pandey A. A survey on risk factors associated with cervical cancer. Indian J Cancer. 2003 Jan- Mar;40:15-22.
8. Mukherjee BN, Sengupta S, Chaudhuri S, Biswas LN, Maiti P.A. case-control study of reproductive risk factors associated with cervical cancer. Int J Cancer. 1994 Nov 15;59:476-82.
9. Gawande V, Wahab SN, Zodpey SP, Vasudeo ND. Risk factors for cancer cervix: a case control study. Indian J Cancer. 1998;35:164-70.
10. Aparajita Dasgupta, Narendra N Naskar, Rama Ram, Sila Deb A. Community Based Study On The Prevalence Of Risk Factors OF Cancer Cervix In Married Women Of A Rural Area Of West Bengal Year. Indian journal of community medicine 2002;27:35-38.
11. International Collaboration of Epidemiological Studies of Cervical Cancer, Appleby P, Beral V, Berrington de González A, Colin D, Franceschi S, Goodhill A, et al. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data on 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet 2007;370:1609-21.
12. Smith JS, Bosetti C, Munoz N, Herrero R, Bosch FX, Eluf-Neto J, et al. IARC Multi-centric Cervical Cancer Study Group. Chlamydia trachomatis and invasive cervical cancer: A pooled analysis of the IARC multicentric case-control study. Int J Cancer 2004;111:431-9.
13. Richardson H, Abrahamowicz M, Tellier PP, Kelsall G, du Berger R, Ferenczy A, et al. Modifiable risk factors associated with clearance of type-specific cervical human papillomavirus infections in a cohort of university students. Cancer Epidemiol Biomarkers Prev 2005;14: 1149-56.
14. Lai CH, Chao A, Chang CJ, Chao FY, Huang HJ, Hsueh S, et al. Host and viral factors in relation to clearance of human papillomavirus infection: a cohort study in Taiwan. Int J Cancer 2008;123:1685-92.
15. Tortolero-Luna G. Epidemiology of genital human papillomavirus. Hematol Oncol Clin North Am 1999;13:245-57.
16. Kjaer SK, Chackerian B, van den Brule AJ, Svare EI, Paull G, Walbomers JM, et al. High-risk human papillomavirus is sexually transmitted: Evidence from a follow-up study of virgins starting sexual activity (intercourse). Cancer Epidemiol Biomarkers Prev 2001;10:101- 6.
17. Schiffman M, Castle PE, Jeronim J, Rodrigue AC, Wacholde S. Human papillomavirus and cervical cancer.Lancet. 2007;370:890–907. [PubMed]
18. Van den Brule AJC, Walboomers JMM, du Maine M, Kenemans P, Meijer CJLM. Difference in prevalence of human papillomavirus genotypes in cytomorphologically normal cervical smears is associated with a history of cervical intraepithelial neoplasia. Int J Cancer 1991;48: 404-8.
19. Resnick RM, Comelissen MTE, Wright DK, Eichinger GH, Fox HS, ter Schegget J, et al. Detection and typing of human papilloma virus in archival cervical cancer specimens by DNA amplification with consensus primers. J Natl Cancer Inst 1990;82:1477-84.
20. Fehrmann F, Laimins LA. Human papillomaviruses targeting differentiating epithelial cells for malignant transformation. Oncogene 2003;22:5201 – 7.
21. Boulet G, Horvath C, Vanden Broeck D, et al. Human papillomavirus:E6 and E7 oncogenes. Int J Biochem Cell Biol 2007;39:2006 – 11.
22. Cattani P, Zannoni GF, Ricci C, et al. Clinical performance of human papillomavirus E6 and E7 mRNA testing for high-grade lesions of the cervix. J ClinMicrobiol 2009;47(12):3895–3901
23. Argyri E, Tsimplaki E, Daskalopoulou D, et al. E6/E7 mRNA expression of high-risk HPV types in 849 Greek women. Anticancer Res 2013;33(9):4007–4011
24. Bamanikar Sunita A., Baravkar Daaso S., Chandanwala Shirish S., Papkikar Prachet. Study of Cervical Pap smears in a Tertiary Hospital. Indian Medical Gazette 2014:250-54.
25. Patel Mandakini M, Pandya Amrish N, Modi Jigna. Cervical Pap Smear Study and its utility in Cancer Screening, to specify the strategy for cervical cancer control. National Journal of Community Medicine 2011;2.
26. Vijaya Lakshmi P., Sree Gouri S.R. Study and Analysis of Two Hundred Cervical PAP Smears in Our Hospital. International Journal of Contemporary Medical Research 2016;3:2787-9.
27. Mishra JS, Srivastava S, Singh U, Srivastava AN. Risk factors and strategies for control of Carcinoma Cervix: Hospital based cytological screening experience of 35 years. Indian Journal of Cancer 2009;46(2).
28. Goes JJS, Goes JC, Lemos LB, Dias JC, Donoso NF, Zyngier SB et al. Practical approaches to screening for cervical cancer. Cancer Detect Prev 1987; 10:265-77
29. Zhang ZF, Parkin DM, Yusz. Risk factors for cancer of cervix in a rural Chinese population. Int J Cancer. 1989;43:762-7.
30. Bauer HM, Hildesheim A, Schiffman MH, et al. Determinants of genital human papillomavirus infection in low-risk women in Portland, Oregon. Sex Transm Dis. 1993;20:274– 278.
31. Hildesheim A, Gravitt P, Schiffman MH, et al. Determinants of genital human papillomavirus infection in low-income women in Washington, DC. Sex Transm Dis. 1993;20:279– 285.
32. Wheeler CM, Parmenter CA, Hunt WC, et al. Determinants of genital human papillomavirus infection among cytologically normal women attending the University of New Mexico student health center. Sex Transm Dis. 1993;20:286–289.

Dr Priya Jain

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