Liquid-Based Cytology and HPV Co-testing in Cervical Cancer Screening for Female Sex Workers: Efficacy and Implications

Authors

  • Anum Rashid Department of Histopathology, Chughtai Institute of Pathology, Pakistan.
  • Aribah Atiq Department of Histopathology, Chughtai Institute of Pathology, Pakistan.
  • Mohammad Azhar Baig Technical Supervisor Cytopathology, Chughtai Institute of Pathology, Pakistan.
  • Akhtar Sohail Chughtai CEO, Chughtai Institute of Pathology, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i4.2981

Keywords:

liquid-based cytology, HPV co-testing, cervical cancer screening, female sex workers, screening efficacy

Abstract

Introduction: Cervical cancer is a significant global health concern related to persistent high-risk HPV infection. Female sex workers (FSWs) are particularly vulnerable. Despite improved screening and prevention, FSWs in developed countries have a disproportionate risk. Liquid-based cytology (LBC) and HPV co-testing are emerging as promising tools for screening, offering improved sensitivity and specificity compared to conventional cytology alone. This research article aims to address the efficacy of LBC and HPV co-testing in cervical cancer screening. Materials and methods: This cross-sectional study whereby female sex workers (FSWs) in Pakistan aged 20 years and above were screened for cervical cancer using human papillomavirus (HPV) genotyping and Liquid-based cytology (LBC). Results: We collected data from 50 female sex workers. On HPV DNA testing, 6(12%) of them tested positive for HPV DNA, 3(6%) of them had HPV 16 infection, 2(4%) had HPV 52, and 1(2%) had HPV 59 infection. The other 44(88%) tested negative for HPV DNA. On liquid-based cytology, 5(10%) showed LSIL, 1(2%) showed ASC-H, and 1(2%) showed ASC-US. Three of the females who were detected positive for HPV also showed changes in LBC. On comparing both techniques, HPV DNA testing showed 82.14% sensitivity and 84% diagnostic accuracy. However, the P-value was significant for both of the techniques. Conclusion: The conventional pap smear, historically the primary method for cervical cancer screening, has limitations, including inadequate sample collection and low sensitivity. Liquid-based cytology and HPV DNA testing are newer methods with benefits and limitations. Combining methods yields good sensitivity and reduces missed diagnoses, making them valuable screening tools.

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References

1. Trottier, H., & Burchell, A. N. (2009). Epidemiology of mucosal human papillomavirus infection and associated diseases. Public Health Genomics, 12(5-6), 291-307.

https://doi.org/10.1159/000214920

2. Eun, T. J., & Perkins, R. B. (2020). Screening for cervical cancer. Medical Clinics of North America, 104(6), 1063-1078.

https://doi.org/10.1016/j.mcna.2020.08.006

3. Nanda, K., McCrory, D. C., Myers, E. R., Bastian, L. A., Hasselblad, V., Hickey, J. D., & Matchar, D. B. (2000). Accuracy of the Papanicolaou test in screening for and follow-up of cervical Cytologic abnormalities. Annals of Internal Medicine, 132(10), 810-819.

https://doi.org/10.7326/0003-4819-132-10-200005160-00009

4. Schiffman, M., Herrero, R., Hildesheim, A., Sherman, M. E., Bratti, M., Wacholder, S., Alfaro, M., Hutchinson, M., Morales, J., Greenberg, M. D., & Lorincz, A. T. (2000). HPV DNA testing in cervical cancer screening. JAMA, 283(1), 87.

https://doi.org/10.1001/jama.283.1.87

5. Sherlaw-Johnson, C., & Philips, Z. (2004). An evaluation of liquid-based cytology and human papillomavirus testing within the UK cervical cancer screening programme. British Journal of Cancer, 91(1), 84-91.

https://doi.org/10.1038/sj.bjc.6601884

6. Levi, J. E., Martins, T. R., Longatto-Filho, A., Cohen, D. D., Cury, L., Fuza, L. M., Villa, L. L., & Eluf-Neto, J. (2019). High-risk HPV testing in primary screening for cervical cancer in the public health system, Sao Paulo, Brazil. Cancer Prevention Research, 12(8), 539-546.

https://doi.org/10.1158/1940-6207.capr-19-0076

7. Landy, R., Pesola, F., Castañón, A., & Sasieni, P. (2016). Impact of cervical screening on cervical cancer mortality: Estimation using stage-specific results from a nested case–control study. British Journal of Cancer, 115(9), 1140-1146.

https://doi.org/10.1038/bjc.2016.290

8. Torre, L. A., Bray, F., Siegel, R. L., Ferlay, J., Lortet‐Tieulent, J., & Jemal, A. (2015). Global cancer statistics, 2012. CA: A Cancer Journal for Clinicians, 65(2), 87-108.

https://doi.org/10.3322/caac.21262

9. Richards, S. D., Stonbraker, S., Halpern, M., & Amesty, S. (2018). Cervical cancer screening among transactional female sex workers in the Dominican Republic. International Journal of STD & AIDS, 29(12), 1204-1214.

https://doi.org/10.1177/0956462418779662

10. Najib, F. S., Hashemi, M., Shiravani, Z., Poordast, T., Sharifi, S., & Askary, E. (2020). Diagnostic accuracy of cervical pap smear and colposcopy in detecting Premalignant and malignant lesions of cervix. Indian Journal of Surgical Oncology, 11(3), 453-458.

https://doi.org/10.1007/s13193-020-01118-2

11. Marcus, J. Z., Cason, P., Downs, L. S., Einstein, M. H., & Flowers, L. (2021). The ASCCP cervical cancer screening task force endorsement and opinion on the American Cancer Society updated cervical cancer screening guidelines. Journal of Lower Genital Tract Disease, 25(3), 187-191.

https://doi.org/10.1097/lgt.0000000000000614

12. Feldstein, O., Gali‐Zamir, H., Schejter, E., Feinberg, T., Yehuda‐Shnaidman, E., Bornstein, J., & Levy, T. (2022). High-risk HPV testing vs liquid-based cytology for cervical cancer screening among 25- to 30-year-old women: A historical cohort study. Acta Obstetricia et Gynecologica Scandinavica, 102(2), 226-233.

https://doi.org/10.1111/aogs.14482

13. Kaufman, H. W., Alagia, D. P., Chen, Z., Onisko, A., & Austin, R. M. (2020). Contributions of liquid-based (Papanicolaou) cytology and human papillomavirus testing in Cotesting for detection of cervical cancer and Precancer in the United States. American Journal of Clinical Pathology, 154(4), 510-516.

https://doi.org/10.1093/ajcp/aqaa074

14. Blatt, A. J., Kennedy, R., Luff, R. D., Austin, R. M., & Rabin, D. S. (2015). Comparison of cervical cancer screening results among 256,648 women in multiple clinical practices. Cancer cytopathology, 123(5), 282-288.

https://doi.org/10.1002/cncy.21544

15. HPV for cervical cancer screening (HPV FOCAL): Complete Round 1 results of a randomized trial comparing HPV‐based primary screening to liquid‐based cytology for cervical cancer - Ogilvie - 2017 - International Journal of Cancer - Wiley Online Library [Internet]. [cited 2025 Mar 12]. https://onlinelibrary.wiley.com/doi/10.1002/ijc.30454

16. Watson, M., Benard, V., & Flagg, E. W. (2018). Assessment of trends in cervical cancer screening rates using healthcare claims data: United States, 2003–2014. Preventive Medicine Reports, 9, 124-130.

https://doi.org/10.1016/j.pmedr.2018.01.010

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Published

2025-04-30

How to Cite

Rashid, A., Atiq, A., Baig, M. A., & Chughtai, A. S. (2025). Liquid-Based Cytology and HPV Co-testing in Cervical Cancer Screening for Female Sex Workers: Efficacy and Implications. Indus Journal of Bioscience Research, 3(4), 1292-1295. https://doi.org/10.70749/ijbr.v3i4.2981