Introduction

At the end of 2019, our efforts to combat uterine cervical cancer (UCC) through laboratory diagnoses were in a transition stage for two reasons: 1) the pandemic caused by the SARS CoV-2 had forced us to repurpose our laboratories for the detection of this virus, and 2) we and other laboratories that had acquired semi-automated platforms for the molecular diagnosis of UCC were encouraging practicing gynecologists to adopt the molecular diagnostics tests as an alternative enabled by these platforms to traditional Papanicolaou and colposcopy tests. Although the impact of SARS-CoV-2 on diagnostic procedures has decreased, we believe that the adoption of new molecular technologies should continue. 

Methods

Cervical samples were taken with an endocervical brush and resuspended in 20 ml of a transportation solution (PreservCyt® solution, Productos Roche SA de CV, Mexico City). Traditional tests consisted of liquid-based cytology on aliquots of the resuspended cells and colposcopy practiced at the referral gynecologists´ offices. For the former, an aliquot was used to prepare smears into slides, and these were stained with the modified Papanicolaou stain. For the molecular tests, a second aliquot of the resuspended cells was used in the COBAS 4800 (Roche) platform to screen for 14 high-risk (HR) human papillomavirus (HPV) types [HPV 16 and HPV 18 individually, while the remaining 12 HR HPV viral types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68)] in a pool. Finally, we used the CINtec® PLUS kit for the dual staining of cancer biomarkers p16 and Ki-67 on the Benchmark® (Roche) immunohistochemistry equipment. 

Results

We have performed more than 4,500 liquid-based cytologies, an equal number of HPV screenings, and more than 500 dual stains for the cancer biomarkers.

The results of our  interactions with practicing  gynecologists can be summarized as follows:

1) There is deeply embedded societal reluctance to abandon traditional PAP tests given the long history of public relations campaigns to convince women and their doctors of their value as the preferred prevention tool for the diagnosis of UCC, and

2) In the opinion of specialists, Colposcopy remains preferred to dual staining protocols despite the invasive and frequently unnecessary practice.

Conclusion

Eradicating UCC still is a challenge in Mexico due to the poor prevention education and the inefficacy of current technology. Our goal is to educate doctors and their patients about the benefits of the new molecular screening technologies for effective primary screening for HPV and the diagnosis of UCC.