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Wilson ML, Fleming KA, Kuti MA, Looi LM, Lago N, Ru K. Access to pathology and laboratory medicine services: a crucial gap. Lancet 2018; 391:1927-1938. [PMID: 29550029 DOI: 10.1016/s0140-6736(18)30458-6] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/28/2017] [Accepted: 12/08/2017] [Indexed: 01/02/2023]
Abstract
As global efforts accelerate to implement the Sustainable Development Goals and, in particular, universal health coverage, access to high-quality and timely pathology and laboratory medicine (PALM) services will be needed to support health-care systems that are tasked with achieving these goals. This access will be most challenging to achieve in low-income and middle-income countries (LMICs), which have a disproportionately large share of the global burden of disease but a disproportionately low share of global health-care resources, particularly PALM services. In this first in a Series of three papers on PALM in LMICs, we describe the crucial and central roles of PALM services in the accurate diagnosis and detection of disease, informing prognosis and guiding treatment, contributing to disease screening, public health surveillance and disease registries, and supporting medical-legal systems. We also describe how, even though data are sparse, these services are of both insufficient scope and inadequate quality to play their key role in health-care systems in LMICs. Lastly, we identify four key barriers to the provision of optimal PALM services in resource-limited settings: insufficient human resources or workforce capacity, inadequate education and training, inadequate infrastructure, and insufficient quality, standards, and accreditation.
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Affiliation(s)
- Michael L Wilson
- Department of Pathology and Laboratory Services, Denver Health, Denver, CO, USA; Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Kenneth A Fleming
- Centre for Global Health, National Cancer Institute, Rockville, MD, USA; Green Templeton College, University of Oxford, Oxford, UK
| | - Modupe A Kuti
- Department of Chemical Pathology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Lai Meng Looi
- Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nestor Lago
- Department of Pathology, University of Buenos Aires, Buenos Aires, Argentina
| | - Kun Ru
- Department of Pathology and Laboratory Medicine, Institute of Hematology, Chinese Academy of Medical Sciences, Tianjin, China
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Anwar SL, Tampubolon G, Van Hemelrijck M, Hutajulu SH, Watkins J, Wulaningsih W. Determinants of cancer screening awareness and participation among Indonesian women. BMC Cancer 2018; 18:208. [PMID: 29506486 PMCID: PMC5838961 DOI: 10.1186/s12885-018-4125-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/12/2018] [Indexed: 02/07/2023] Open
Abstract
Background Cancer screening awareness and participation may be lower in low- and middle-income countries that lack established national screening programmes compared with those that do. We evaluated potential determinants of awareness about and participation in breast and cervical cancer screening, and breast self-examination (BSE) in women using survey data from Indonesia. Methods From the fifth Indonesian Family Life Survey (2014–2015), a total of 5397 women aged 40 and older without any history of cancer who responded to questionnaires concerning Pap smears, mammography, and BSE were included. Multilevel modelling was used to assess potential determinants in relation to awareness about Pap smears and mammography, and participation in Pap smears and BSE practice. Multivariable analyses were performed to identify independent predictors of cancer screening. Results Of the 5397 respondents, 1058 (20%) women were aware of Pap smears, of which 297 had never had the procedure. Only 251 (5%) participants were aware of mammography. A total of 605 (12%) of women reported they performed BSE. Higher education and household expenditure were consistently associated with higher odds of awareness about Pap smears and mammography (e.g. odds ratio [OR] of being aware of Pap smear and mammography: 7.82 (95% CI: 6.30–9.70) and 7.70 (6.19–9.58), respectively, for high school graduates compared to women with less educational attainment in the multivariable models), and participation in Pap smears and BSE. We also identified enabling factors linked with greater cancer screening awareness and participation, including health insurance, shorter distance to health services, and social participation. Conclusion There are socioeconomic disparities in cancer screening awareness and participation among Indonesian women. Our findings may help inform targeted health promotion and screening for cancer in the presence of limited resources. Electronic supplementary material The online version of this article (10.1186/s12885-018-4125-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sumadi L Anwar
- Division of Surgical Oncology Department of Surgery, Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.,PILAR Research and Education, 20 Station Road, Cambridge, CB1 2JD, UK
| | - Gindo Tampubolon
- Cathie Marsh Institute for Social Research, University of Manchester, M13 9PL, Manchester, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, King's College London, London, SE1 9RT, UK
| | - Susanna H Hutajulu
- Division of Medical Haematology and Oncology Department of Internal Medicine, Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Johnathan Watkins
- PILAR Research and Education, 20 Station Road, Cambridge, CB1 2JD, UK
| | - Wahyu Wulaningsih
- PILAR Research and Education, 20 Station Road, Cambridge, CB1 2JD, UK. .,MRC Unit for Lifelong Health and Ageing, University College London, Place London WC1B 5JU, Bedford, 33, UK.
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Ebell MH, Thai TN, Royalty KJ. Cancer screening recommendations: an international comparison of high income countries. Public Health Rev 2018; 39:7. [PMID: 29507820 PMCID: PMC5833039 DOI: 10.1186/s40985-018-0080-0] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/12/2018] [Indexed: 12/22/2022] Open
Abstract
Background Recommendations regarding cancer screening vary from country to country, and may also vary within countries depending on the organization making the recommendations. The goal of this study was to summarize the cancer screening recommendations from the 21 countries with the highest per capita spending on healthcare. Main body Cancer screening guidelines were identified for each country based on a review of the medical literature, internet searches, and contact with key informants in most countries. The highest level recommendation was identified for each country, in the order of national recommendation, cancer society recommendation, or medical specialty society recommendation. Breast cancer screening recommendations were generally consistent across countries, most commonly recommending mammography biennially from ages 50 to 69 or 70 years. In the USA, specialty societies generally offered more intensive screening recommendations. All countries also recommend cervical cancer screening, although there is some heterogeneity regarding the test (cytology or HPV or both) and the age of initiation and screening interval. Most countries recommend colorectal cancer screening using fecal immunochemical (FIT) testing, while only seven countries recommend general or selective screening for prostate cancer, and a similar number explicitly recommend against screening for prostate cancer. Screening for lung and skin cancer is only recommended by a few countries. Greater per capita healthcare expenditures are not associated with greater screening intensity, with the possible exception of prostate cancer. Conclusions Guidelines for cancer screening differ between countries, with areas of commonality but also clear differences. Recommendations have important commonalities for well-established cancer screening programs such as breast and cervical cancer, with greater variation between countries regarding prostate, colorectal, lung, and skin cancer screening. Ideally, recommendations should be made by a professionally diverse, independent panel of experts that make evidence-based recommendations regarding screening based on the benefits, harms, and available resources in that country’s context.
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Affiliation(s)
- Mark H Ebell
- 1College of Public Health, University of Georgia, 125 Miller Hall, UGA Health Sciences, GA 30602 Athens, Georgia USA
| | - Thuy Nhu Thai
- 2Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida USA
| | - Kyle J Royalty
- Augusta University/University of Georgia Medical Partnership Campus, Athens, Georgia USA
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Expression of Yin Yang 1 in cervical cancer and its correlation with E-cadherin expression and HPV16 E6. PLoS One 2018; 13:e0193340. [PMID: 29470526 PMCID: PMC5823405 DOI: 10.1371/journal.pone.0193340] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/08/2018] [Indexed: 01/18/2023] Open
Abstract
The molecular mechanisms of normal cervical squamous epithelium advancing to cervical intraepithelial neoplasia (CIN) and eventually to cervical squamous cell carcinoma (CSCC) are largely unknown. This study explored abnormal expression of Yin Yang 1 (YY1) in cervical cancer and its correlation with the expression of E-cadherin and human papillomavirus (HPV) 16 E6. YY1, E-cadherin and HPV16 E6 expression were detected by immunohistochemistry in 90 cervical tissue specimens collected from 30 patients with hysteromyoma, 15 patients with CIN I, 15 patients with CIN II-III, and 30 patients with CSCC. The H-score method was employed to measure the expression of YY1, E-cadherin and HPV16 E6. Increased expression of YY1 and HPV16 E6, and the decreased expression levels of E-cadherin were strongly associated with malignant transformation of the cervical epithelium and the histological progression of CSCC. The expression of YY1 in cervical tissues was inversely correlated with E-cadherin expression, and positively correlated with HPV16 E6 expression. Expression of YY1 in CSCC tissues was not significantly correlated with tumor differentiation, but was significantly correlated with an advanced clinical stage of CSCC. These results suggest that up-regulation of YY1 is closely associated with the progression of CSCC, and YY1 may play an important role in the pathogenesis of cervical cancer by modulating the expression of E-cadherin and HPV16 E6.
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Ndizeye Z, Vanden Broeck D, Vermandere H, Bogers JP, Van Geertruyden JP. Knowledge and practices of general practitioners at district hospitals towards cervical cancer prevention in Burundi, 2015: a cross-sectional study. Global Health 2018; 14:4. [PMID: 29338741 PMCID: PMC5771039 DOI: 10.1186/s12992-018-0321-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/05/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Well-organized screening and treatment programmes are effective to prevent Invasive Cervical Cancer (ICC) in LMICs. To achieve this, the World Health Organization (WHO) recommends the involvement of existing health personnel in casu doctors, nurses, midwives in ICC prevention. A necessary precondition is that health personnel have appropriate knowledge about ICC. Therefore, to inform policy makers and training institutions in Burundi, we documented the knowledge and practices of general practitioners (GPs) at district hospital level towards ICC control. METHODS A descriptive cross-sectional survey was conducted from February to April, 2015 among all GPs working in government district hospitals. A structured questionnaire and a scoring system were used to assess knowledge and practices of GPs. RESULTS The participation rate was 58.2%. Majority of GPs (76.3%) had appropriate knowledge (score > 70%) on cervical cancer disease; but some risk factors were less well known as smoking and the 2 most important oncogenic HPV. Only 8.4% of the participants had appropriate knowledge on ICC prevention: 55% of the participants were aware that HPV vaccination exists and 48.1% knew cryotherapy as a treatment method for CIN. Further, 15.3% was aware of VIA as a screening method. The majority of the participants (87%) never or rarely propose screening tests to their clients. Only 2 participants (1.5%) have already performed VIA/VILI. Wrong thoughts were also reported: 39.7% thought that CIN could be treated with radiotherapy; 3.1% thought that X-ray is a screening method. CONCLUSION In this comprehensive assessment, we observed that Burundian GPs have a very low knowledge level about ICC prevention, screening and treatment. Suboptimal practices and wrong thoughts related to ICC screening and treatments have also been documented. We therefore recommend an adequate pre- and in-service training of GPs and most probably nurses on ICC control before setting up any public health intervention on ICC control.
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Affiliation(s)
- Zacharie Ndizeye
- Faculty of Medicine, Community Medicine Department, University of Burundi, Bujumbura, Burundi. .,Faculty of Medicine and health sciences, Global Health Institute, University of Antwerp, Antwerp, Belgium.
| | - Davy Vanden Broeck
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,Laboratory of Molecular Pathology, AML, Antwerp, Belgium.,AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium
| | - Heleen Vermandere
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - John Paul Bogers
- Faculty of Medicine and health sciences, Global Health Institute, University of Antwerp, Antwerp, Belgium.,International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,Laboratory of Molecular Pathology, AML, Antwerp, Belgium.,AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium
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Detection and genotyping of HPV in urine samples from Chilean women attending primary health care centers. Med Microbiol Immunol 2017; 207:95-103. [PMID: 29238853 DOI: 10.1007/s00430-017-0530-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/09/2017] [Indexed: 12/22/2022]
Abstract
Cervical cancer is the second most common malignant neoplasm in women worldwide representing approximately 10% of all types of cancers. Triage of women through cervical cytology has been an important strategy for the surveillance and control of new cases of cervical cancer. However, in many regions around the world cervical cytology has a low coverage compared to developed countries. The molecular detection of HPV is the most effective method to increase the screening sensitivity of women at risk of developing cervical cancer. There are very few studies about the efficacy of urine testing for detection of HPV in women followed up in primary health care centers. Consequently, the efficacy of using urine HPV screening in these populations has not been addressed yet. Here, we compared the detection of HPV in simultaneous urine and cervical samples of women followed up in primary health care centers. Urine and cervical samples were analyzed in 543 women attending at primary health care centers. HPV was detected by real time PCR, and HPV typing performed by PCR-RLB. A general HPV concordance of 86.2% (κ = 0.72) was determined between urine and cervical samples. The concordance for HPV-16 and 18 was almost perfect (κ = 0.82) and strong (κ = 0.77), respectively. The sensitivity and specificity for all HPV genotypes in urine using cervical samples as reference were 82.1 and 93.7%, respectively. The results showed that urine is a good alternative as clinical sample for HPV screening in women attending primary health care centers. Therefore, urine should be used as an alternative sample for increasing triage coverage either in refractory women participating in Pap surveillance programs or when cervical samples are not available.
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Tiruneh FN, Chuang KY, Ntenda PAM, Chuang YC. Individual-level and community-level determinants of cervical cancer screening among Kenyan women: a multilevel analysis of a Nationwide survey. BMC WOMENS HEALTH 2017; 17:109. [PMID: 29141612 PMCID: PMC5688646 DOI: 10.1186/s12905-017-0469-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 11/08/2017] [Indexed: 12/22/2022]
Abstract
Background Studies on the determinants of cervical cancer screening in sub-Saharan Africa have focused mostly on individual-level characteristics of cervical cancer screening. Therefore, in this study, we included both individual- and community-level indicators to examine the determinants of cervical cancer screening among Kenyan women. Methods We analyzed data from the 2014 Kenya Demographic and Health Surveys. Our analysis focused on 9016 married women of reproductive age (15–49 years). We conducted multilevel analyses using generalized linear mixed models with the log-binomial function to simultaneously analyze the association of individual- and community-level factors with cervical cancer screening. Results About 72.1% of women (n = 6498) knew about cervical cancer. Of these women, only 19.4% had undergone cervical cancer screening [58.24% Papanicolaou (Pap) test and 41.76% visual inspection]. Our multivariate analysis results indicated that the prevalence of cervical cancer screening was higher among women aged 35-49 years than women aged 15-24 years. The prevalence was also higher among women residing in the Central, Nyanza, and Nairobi regions than women residing in the Coastal region. Cervical cancer screening was more prevalent among women who had media exposure, had higher household wealth index, were employed, were insured, and had visit a health facility in 12 months than did their counterparts. The prevalence of Pap test history was 19% higher among women who had sexual autonomy than women who did not have sexual autonomy. The prevalence of Pap test history was also higher among communities comprised of higher proportions of women with sexual autonomy and higher education. Conclusions Policies should emphasize increasing gender equality, improving education at the community level, providing employment opportunities for women, and increasing universal health insurance coverage. These focal points can ensure equity in access to health care services and further increase the prevalence of cervical cancer screening in Kenya.
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Affiliation(s)
- Fentanesh Nibret Tiruneh
- School of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan, 110
| | - Kun-Yang Chuang
- School of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan, 110
| | | | - Ying-Chih Chuang
- School of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan, 110.
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Alshamsan R, Lee JT, Rana S, Areabi H, Millett C. Comparative health system performance in six middle-income countries: cross-sectional analysis using World Health Organization study of global ageing and health. J R Soc Med 2017; 110:365-375. [PMID: 28895493 DOI: 10.1177/0141076817724599] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective To assess and compare health system performance across six middle-income countries that are strengthening their health systems in pursuit of universal health coverage. Design Cross-sectional analysis from the World Health Organization Study on global AGEing and adult health, collected between 2007 and 2010. Setting Six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Participants Nationally representative sample of adults aged 50 years and older. Main outcome measures We present achievement against key indicators of health system performance across effectiveness, cost, access, patient-centredness and equity domains. Results We found areas of poor performance in prevention and management of chronic conditions, such as hypertension control and cancer screening coverage. We also found that cost remains a barrier to healthcare access in spite of insurance schemes. Finally, we found evidence of disparities across many indicators, particularly in the effectiveness and patient centredness domains. Conclusions These findings identify important focus areas for action and shared learning as these countries move towards achieving universal health coverage.
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Affiliation(s)
- Riyadh Alshamsan
- 1 College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11632, Saudi Arabia.,2 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London SW7 2AZ, UK
| | - John Tayu Lee
- 2 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London SW7 2AZ, UK.,3 Saw Swee Hock School of Public Health, University of Singapore, Singapore 117549
| | - Sangeeta Rana
- 4 Field Epidemiology Service South East and London, Public Health England, London SE1 6LH, UK.,5 Imperial College Healthcare NHS Trust, London SW7 2AZ, UK
| | - Hasan Areabi
- 1 College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11632, Saudi Arabia
| | - Christopher Millett
- 2 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London SW7 2AZ, UK
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Bai Y, Liu Q, Chen X, Gao Y, Gong H, Tan X, Zhang M, Tuo J, Zhang Y, Xiang Q, Deng F, Liu G. Protection motivation theory in predicting intention to receive cervical cancer screening in rural Chinese women. Psychooncology 2017; 27:442-449. [PMID: 28749603 DOI: 10.1002/pon.4510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/14/2017] [Accepted: 07/21/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Yang Bai
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Qing Liu
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Xinguang Chen
- School of Health Sciences; Wuhan University; Wuhan Hubei China
- Department of Epidemiology; University of Florida; Gainesville FL USA
| | - Yanduo Gao
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Huiyun Gong
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Xiaodong Tan
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Min Zhang
- Institute of Cancer Prevention and Control; Wuhan Hubei China
| | - Jiyu Tuo
- Institute of Cancer Prevention and Control; Wuhan Hubei China
| | - Yuling Zhang
- Institute of Cancer Prevention and Control; Wuhan Hubei China
| | - Qunying Xiang
- Maternal and Child Health Care Hospital; Wufeng Hubei China
| | - Fenghua Deng
- Maternal and Child Health Care Hospital; Wufeng Hubei China
| | - Guiling Liu
- Maternal and Child Health Care Hospital; Wufeng Hubei China
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Kunckler M, Schumacher F, Kenfack B, Catarino R, Viviano M, Tincho E, Tebeu PM, Temogne L, Vassilakos P, Petignat P. Cervical cancer screening in a low-resource setting: a pilot study on an HPV-based screen-and-treat approach. Cancer Med 2017; 6:1752-1761. [PMID: 28580596 PMCID: PMC5504339 DOI: 10.1002/cam4.1089] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/30/2017] [Accepted: 03/31/2017] [Indexed: 01/24/2023] Open
Abstract
Cervical cancer (CC) is the leading cause of cancer‐related death among women in sub‐Saharan Africa, primarily because of limited access to effective screening and preventive treatment. Our aim was to assess the feasibility of a human papillomavirus (HPV)‐based CC screen‐and‐treat approach in a low‐resource context. We recruited 1012 women aged 30–49 years through a CC screening campaign conducted in the District Hospital of Dschang, Cameroon. Participants performed HPV self‐sampling, which was tested for high‐risk HPV (HR‐HPV) DNA using the point‐of‐care Xpert HPV assay. All HPV‐positive women were invited for visual inspection with acetic acid and Lugol's iodine (VIA/VILI) to exclude CC or enable triage. A cervical sample for histological analysis was also collected. Women positive for HPV 16/18/45 and for other HR‐HPV with pathological VIA/VILI were selected to undergo treatment with thermocoagulation. The HPV prevalence in the study population was 18.5% (n = 187); of these cases, 20 (10.6%), 42 (22.3%) and 140 (74.9%) were positive for HPV16, HPV18/45 and other HR‐HPV types, respectively. Overall, 107/185 (57.8%) VIA/VILI examinations were classified as pathological and 78 (42.2%) as normal. Women positive for HPV16/18/45 were 4.2 times more likely to harbor cervical intraepithelial neoplasia grade 2 or worse (CIN2+) than those with other HPV types. The specificity of HPV 16/18/45 genotypes for detection of high‐grade lesions among HR‐HPV positive women was higher than that of VIA/VILI in all age groups. The sensitivity and specificity of VIA/VILI in detecting CIN2+ among HPV positive women were 80% and 44%, respectively. Overall, 110/121 screen‐positive women (90.9%) were eligible for, and were treated with, thermocoagulation. An HPV‐based screen‐and‐treat approach is feasible in a low‐resource context and may contribute to improving the effectiveness of CC prevention programs. Immediate thermocoagulation treatment for women who are HPV16‐ and/or HPV18/45‐positive is a practical approach for the treatment of CIN2+. The combination of HPV‐testing and VIA/VILI for CC screening might reduce overtreatment.
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Affiliation(s)
- Margot Kunckler
- Gynecology Division, Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland
| | - Fanny Schumacher
- Gynecology Division, Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland
| | - Bruno Kenfack
- Department of Biomedical Sciences, University of Dschang, Dschang District Hospital, Dschang, Cameroon
| | - Rosa Catarino
- Gynecology Division, Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland
| | - Manuela Viviano
- Gynecology Division, Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland
| | - Eveline Tincho
- Faculty of Medicine and Biomedical Sciences, Centre Hospitalier Universitaire (CHUY), Yaoundé, Cameroon
| | - Pierre-Marie Tebeu
- Faculty of Medicine and Biomedical Sciences, Centre Hospitalier Universitaire (CHUY), Yaoundé, Cameroon
| | - Liliane Temogne
- Faculty of Medicine and Biomedical Sciences, Centre Hospitalier Universitaire (CHUY), Yaoundé, Cameroon
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Patrick Petignat
- Gynecology Division, Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland
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