Development and evaluation of a cervical cancer screening system in Cambodia: A collaborative project of the Cambodian Society of Gynecology and Obstetrics and Japan Society of Obstetrics and Gynecology

Abstract

Aim In Cambodia, the Japan Society of Obstetrics and Gynecology and the Cambodian Society of Gynecology and Obstetrics have an on‐going project, started in 2015, for cervical cancer prevention and treatment. The project, currently aimed at factory workers, includes a women’s health education program that leads into cervical cancer prevention by establishment of a system for early detection and treatment. It begins by health education, screening for human papillomavirus (HPV), followed by colposcopy and quicker treatment of earlier precursor lesions. Methods Rates for participant screening, HPV test positivity, cervical intraepithelial neoplasia (CIN) detection and distribution of HPV types were compared between two screening programs, factory‐based and hospital‐based. Some HPV test samples were divided into two, one of which was sent to Japan for a quality‐control check of the Cambodian testing. Results The factory‐based participant screening rate was 19% (128/681). HPV was detected more frequently in the factory‐based program participants (12%) than in the hospital‐based program participants (5%). Unfortunately, however, the rate of receiving proper secondary colposcopy screening among the HPV‐positive females was significantly higher in the hospital‐based program (94%) than the factory‐based program (40%) ( P < 0.001). The Cambodian laboratory HPV testing accuracy was 92.6%. HPV types demonstrated no significant difference between the two prevention programs. Conclusion We could successfully introduce HPV‐based screening, starting from health education. However, low rate of screening, especially secondary screening for HPV positive factory workers was identified. Also, HPV testing could be further improved for accuracy through close monitoring.

Current Updates on Cancer-Causing Types of Human Papillomaviruses (HPVs) in East, Southeast, and South Asia

“…Commonly used primer pairs include the standard PGMY09/11 or GP5+/GP6+ L1 consensus primers [ 127 , 128 , 130 , 131 ] and PCR primers targeting HPVE6/E7 [ 52 , 112 , 116 , 132 , 133 , 134 ] or E6*I [ 85 ], both of which are followed by HPV genotype discrimination using Sanger sequencing [ 55 , 101 , 135 , 136 , 137 ]. Many laboratories have also employed the PGMY-CHU assay [ 138 , 139 ] which is outlined in the WHO HPV Laboratory Manual [ 111 ], in which the HPVL1 that is amplified using PGMY09/11 primers is detected via reverse blotting hybridization. Additionally, HPV mRNA and signal amplification can be detected via liquid-phase or in situ hybridization methods, as applied in Hybrid Capture 2 (HC2) (Qiagen Gaithersburg, MD, USA) [ 85 ].…”

“…Japanese research teams have also collaborated with Mongolia, Cambodia, and Laos in HPV epidemiological studies. In these studies, the clinical samples collected by local gynaecologists were sent to laboratories in Japan for analyses using validated methods like the Linear Array HPV Genotyping Test (Roche Molecular Systems, Branchburg, NJ, USA) [ 49 ] and PGMY-CHU assay [ 139 ], as well as an in-house designed methods to identify fragments of restriction-enzyme-digested, HPV genotype-targeted PCR amplicons [ 76 ].…”

The cooperation between professional societies contributes to the capacity building and system development for prevention and control of cancer in low- and middle-income countries: the practice of Cervical Cancer Prevention and Control Project in Cambodia

“…The collected cervical samples were sent to one of the national hospital laboratories where trained technicians performed the HPV assay. They became competent handling the HPV assay after one-month training with sufficient proficiency confirmed by a control laboratory in Japan (12). For women who tested positive, considering the risk of overtriage (13), a follow-up examination was scheduled at one of the target hospitals for Phase B.…”

Knowledge and practice for cervical cancer among female primary school teachers in Phnom Penh, Cambodia: A cross-sectional phone-based survey

“…However, according to the 2016 STEP survey, only 11.3% of Cambodian women aged 18-69 years have ever been screened, indicating that cervical cancer screening is not yet widespread (17). Although the knowledge and understanding of the target women are essential to encourage them to undergo cervical cancer screening, there is limited information regarding knowledge and practice concerning cervical cancer among women in Cambodia (10,18,19). Since HPV vaccination is planned to be introduced as a routine immunization to 9-year-old girls in primary schools in 2023, primary school teachers are considered key influencers to school children and their parents who make a decision for vaccination (20).…”