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Sabeena S, Ravishankar N, Kalpana MM. Implementation strategies of cervical cancer screening in South Asia: A systematic review. Int J Gynaecol Obstet 2024; 166:483-493. [PMID: 38268412 DOI: 10.1002/ijgo.15366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/23/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Cervical cancer is a preventable cancer by screening, vaccination and timely management of preinvasive cervical lesions. However, about 90% of the global burden of cervical cancer is reported from developing countries. OBJECTIVE This systematic review aimed to analyze the strategies implemented for cervical cancer screening in South Asia. SEARCH STRATEGY An electronic search of PubMed/MEDLINE, Scopus and Google Scholar was carried out for articles published in English, evaluating the implementation of cervical cancer screening between December 2000 and June 2023 in South Asia using appropriate search terms. SELECTION CRITERIA Cross-sectional studies, randomized control trials (RCTs) or non-randomized controlled trials evaluating different cervical screening strategies were included. DATA COLLECTION AND ANALYSIS A three-stage selection process was performed using a validated proforma including the title, author, year of publication, objective, country, study design, screening methods, strategies and outcomes, and results. The systematic review was designed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was evaluated with the National Heart, Lung, and Blood Institute's (NHLBI) Quality Assessment Tools. MAIN RESULTS Out of the initial 1135 articles reviewed systematically, 23 studies met the inclusion criteria and were included in the qualitative synthesis of results. The implementation outcomes measured were acceptability (n = 23 100%), feasibility (n = 22, 95.7%), fidelity (n = 14, 60.9%), sustainability (n = 7, 30.4%), coverage (n = 4, 17.4%) and cost (n = 1, 4.3%). CONCLUSION Cervical cancer screening can be effectively implemented by restructuring the ongoing programs.
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Affiliation(s)
| | - Nagaraja Ravishankar
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - M M Kalpana
- Department of Obstetrics and Gynecology, Government Medical College, Kozhikode, Kerala, India
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Pulido E, González M, Gamboa Ó, Bonilla J, Luna J, Murillo R. Effectiveness of cryotherapy delivered by nurses for treatment of cervical preneoplasic lesions. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:79-87. [PMID: 38207156 PMCID: PMC10901276 DOI: 10.7705/biomedica.6966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/25/2023] [Indexed: 01/13/2024]
Abstract
Introduction. Cervical cancer is a relevant public health problem for low- and middleincome countries. Follow-up of positive-screened women and compliance with treatment of precancerous lesions are major challenges for these settings. Objective. To evaluate the efficacy of cryotherapy delivered by nurses for cervical intraepithelial neoplasia (CIN). Materials and methods. Direct visual inspection with acetic acid and lugol iodine (VIAVILI), and colposcopy/biopsy were performed on women 25 to 59 years old, residents of low-income areas in Bogotá, Colombia. Trained nurses offered immediate cryotherapy to every woman with positive visual inspection. Colposcopy/biopsy was performed before treatment and at a 12-month follow-up. The effectiveness was measured as cure (outcome: no-lesion) and regression (outcome: CIN1) rates of CIN2/3 using colposcopic and histological verification. Results. A group of 4.957 women with VIA/VILI was valuated. In total, 499 were screen positive and 472 accepted immediate treatment. A total of 365 women (11 CIN2/3) received cryotherapy by nurses. Cure rate was 72% (95%CI: 39%-94%) and 40% (95%CI: 22%-85%) by colposcopic and histological verification, respectively. Regression rates were 100% and 60%. There were two related non-serious adverse events. Conclusions. Cure and regression rates by colposcopic verification are like those reported for cryotherapy delivered by doctors. The sample size (CIN2/3) hinders comparisons by type of verification. Our findings support the implementation of screen-and-treat algorithms by nurses among populations with limited access to health services.
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Affiliation(s)
- Edwin Pulido
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, D.C., Colombia.
| | - Mauricio González
- Emeritus, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
| | - Óscar Gamboa
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, D.C., Colombia; Servicio de Radioterapia, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
| | | | | | - Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, D.C., Colombia; Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia.
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Soler M, Lu E, Masch R, Alfaro K, Anderson JR, Cremer M. Affordable cancer technologies: Lessons learned from the design and implementation of two randomized clinical trials to develop innovative treatments for cervical precancer. Contemp Clin Trials Commun 2023; 36:101224. [PMID: 38028323 PMCID: PMC10663751 DOI: 10.1016/j.conctc.2023.101224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/24/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Montserrat Soler
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
- Basic Health International, San Salvador, El Salvador and Pittsburgh, PA, USA
| | | | - Rachel Masch
- Basic Health International, San Salvador, El Salvador and Pittsburgh, PA, USA
| | - Karla Alfaro
- Basic Health International, San Salvador, El Salvador and Pittsburgh, PA, USA
| | - Jean R. Anderson
- Jhpiego, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Miriam Cremer
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
- Basic Health International, San Salvador, El Salvador and Pittsburgh, PA, USA
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van Henten S, Pareyn M, Tadesse D, Kassa M, Techane M, Kinfe E, Girma N, Demeke D, Mesay M, Kassa M, Temesgen R, Shewangizaw M, Massebo F, van Griensven J, Wegayehu T, Merdekios B. Community-based treatment of cutaneous leishmaniasis using cryotherapy and miltefosine in Southwest Ethiopia: the way forward? Front Med (Lausanne) 2023; 10:1196063. [PMID: 37886367 PMCID: PMC10598589 DOI: 10.3389/fmed.2023.1196063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Background Cutaneous leishmaniasis (CL) is a common, yet massively underreported skin morbidity in Ethiopia. Most patients never seek treatment, as this is offered only in specialized treatment centers. Early diagnosis and treatment through decentralization is crucial to decrease transmission and to reach the NTD roadmap goals. However, little information is available on outcomes and challenges of community-based treatment initiatives. Methods A community-based prospective cohort study was conducted in Ochollo. Patients with clinically or microscopy confirmed CL were included. Cryotherapy was (to be) given weekly with at least four sessions for uncomplicated lesions, and miltefosine was given for 4 weeks for complicated lesions. Miltefosine adherence was assessed by counting pill strips. Clinical and patient-reported outcomes (dermatological life quality index and patient-global assessment) were assessed at month 6 (M6). Results A total of 107 patients were included, with a median age of 6 years. Two patients refused, and 15 could not be treated as they were too young (<4 years) for miltefosine. Giving cryotherapy to patients weekly was not feasible due to long wound healing times and required use of topical antibiotics. Only 52.4% of miltefosine patients finished >90% of their tablets by M1. Among 46 patients treated with cryotherapy, 24 (52.2%) were cured at M6, and 9 (19.6%) had substantial improvement. The cure rate was 16/39 (41.0%) for miltefosine with 28.2% (11/39) substantial improvement. Before treatment, more than half (57.8%) of patients reported that CL did not negatively impact their life, which significantly increased to 95.2% at M6. At this time, 61.7% of patients said their lesion was clear, which was 1% before treatment. Conclusion Our study is the first to identify the challenges and opportunities of miltefosine and cryotherapy for community treatment of CL. Although overall cure rates were lower than expected, patient-reported outcomes were generally positive and quite some patients had good improvement.
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Affiliation(s)
- Saskia van Henten
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Myrthe Pareyn
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Dagimawie Tadesse
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Mekidim Kassa
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Mehret Techane
- Department of Dermatology, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Eyerusalem Kinfe
- Department of Dermatology, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Nigatu Girma
- Department of Biology, College of Natural and Computational Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Degnet Demeke
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Mebratu Mesay
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Mekibib Kassa
- Leishmaniasis Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Rodas Temesgen
- Department of Internal Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Misgun Shewangizaw
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Fekadu Massebo
- Department of Biology, College of Natural and Computational Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Teklu Wegayehu
- Department of Biology, College of Natural and Computational Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Behailu Merdekios
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Soler M, Alfaro K, Masch RJ, Conzuelo Rodriguez G, Qu X, Wu S, Sun J, Hernández Jovel DM, Bonilla J, Puentes LO, Murillo R, Alonzo TA, Felix JC, Castle P, Cremer M. Safety and Acceptability of Three Ablation Treatments for High-Grade Cervical Precancer: Early Data From a Randomized Noninferiority Clinical Trial. JCO Glob Oncol 2022; 8:e2200112. [PMID: 36525620 PMCID: PMC10166394 DOI: 10.1200/go.22.00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE This ongoing trial is comparing the efficacy and safety of three ablation treatments for cervical intraepithelial neoplasia grade 2 or higher. Here, we present early data regarding pain, side effects, and acceptability of CO2 gas-based cryotherapy (CO2), nongas cryotherapy, and thermal ablation (TA). Efficacy results are expected to become available in late 2023. MATERIALS AND METHODS This noninferiority randomized trial is taking place in El Salvador, China, and Colombia. Patients are 1,152 eligible women with biopsy-confirmed cervical intraepithelial neoplasia grade 2 or higher who will receive one of three ablation treatments. Pain is measured before, during, and after treatment with a visual analog scale (1-10). Side effects and acceptability are assessed at 6 weeks. RESULTS To date, 1,024 of 1,152 (89%) women were randomly assigned to treatment. The median pain level was higher during TA (4, IQR = 4) than CO2 (2, IQR = 4) or nongas cryotherapy (2, IQR = 4) (P < .01, range: 0-10). The most common post-treatment symptom was watery discharge, reported by 97.9% of women, and it lasted longer in the CO2 group than the other two treatments (in days, median [IQR]: CO2 = 20[20], nongas cryotherapy = 15[10], TA = 18[15], P < .01). Bleeding was reported more frequently in women treated with TA (27.6%) than CO2 (17.5) or nongas cryotherapy (18.7%) (P < .01). The majority of patients reported being very satisfied with the treatment they received at 6 weeks (91%) and again at 12 months post-treatment (97%). CONCLUSION Despite differences in pain and side effects across ablation treatments, all were safe and highly acceptable to patients. In addition to efficacy, considerations such as cost and portability may be more significant in choosing a treatment method.
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Affiliation(s)
- Montserrat Soler
- Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH.,Basic Health International, Pittsburgh, PA; San Salvador, El Salvador
| | - Karla Alfaro
- Basic Health International, Pittsburgh, PA; San Salvador, El Salvador
| | - Rachel J Masch
- Basic Health International, Pittsburgh, PA; San Salvador, El Salvador
| | | | - Xinfeng Qu
- Basic Health International, Pittsburgh, PA; San Salvador, El Salvador
| | - Suhui Wu
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Jingfen Sun
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | | | - Jairo Bonilla
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Luis Orlando Puentes
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Todd A Alonzo
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Juan C Felix
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| | - Philip Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Miriam Cremer
- Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH.,Basic Health International, Pittsburgh, PA; San Salvador, El Salvador
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Narasimhamurthy M, Kafle SU. Cervical cancer in Nepal: Current screening strategies and challenges. Front Public Health 2022; 10:980899. [PMID: 36466479 PMCID: PMC9713638 DOI: 10.3389/fpubh.2022.980899] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
Nepal has a high burden of cervical cancer primarily due to a limited screening program. Most present with advanced cervical disease. Despite no national cervical cancer control program, Nepal's Ministry of Health and Population has taken many initiatives with various international collaborations in screening, vaccination, and treating pre-invasive and invasive cancer. However, the existing prevention and treatment modalities are dismally inadequate to meet the targets of WHO's cervical cancer eliminative initiative by 2030. We provide an overview of the Ministry of Health and Population, Nepal's efforts to tackle the growing cervical cancer burden in the country. We discuss the challenges and potential solutions that could be practical and augment screening uptakes, such as single-dose vaccination and HPV DNA tests. The screen-and-treat approach on the same day could potentially address treatment delays and follow-up loss after testing positive. Our narrative summary highlights existing and innovative strategies, unmet needs, and collaborations required to achieve elimination across implementation contexts.
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Affiliation(s)
- Mohan Narasimhamurthy
- Department of Pathology and Laboratory Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA, United States,*Correspondence: Mohan Narasimhamurthy
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Wilkin T, Chen H, Sahasrabuddhe V, Matining R, Mngqibisa R, Chinula L, Mbilizi Y, Magure T, Omoz-Oarhe AE, Rassool M, Riviere C, Bhosale R, Godbole S, Naranjo R, Coombs R, Michelow P, Godfrey C, Firnhaber C. A Randomized Clinical Trial of Human Papillomavirus Test-and-Treat as Compared to Cytology-Based Screening for Prevention of Cervical Cancer Among Women With Human Immunodeficiency Virus: AIDS Clinical Trials Group Protocol A5282. Clin Infect Dis 2022; 75:1280-1288. [PMID: 35294524 PMCID: PMC9555836 DOI: 10.1093/cid/ciac213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cytology-based cervical cancer screening followed by confirmation and treatment of biopsy-proven high-grade squamous intraepithelial lesions (bHSIL) is difficult to implement in resource-constrained settings. We hypothesized that high-risk human papillomavirus (hrHPV) testing followed by immediate cryotherapy of women with hrHPV (HPV screen-and-treat) may improve outcomes. METHODS Randomized, open-label, phase 2, multinational clinical trial enrolling women with human immunodeficiency virus (HIV) age 18 or older with cervical hrHPV and having no cervical lesions or lesions appropriate for cryotherapy. Women were randomized to immediate cryotherapy (Arm A) or cytology-based screening (Arm B). For Arm A, cervical biopsies were obtained followed by cervical cryotherapy, and in Arm B, women with abnormal cytology underwent colposcopy followed by loop electroexcision procedure (LEEP) if bHSIL was detected. Women were followed through 30 months. The primary outcome was time to bHSIL detected from Month 6 through study completion. RESULTS In total, 288 women (145 in Arm A, 143 in Arm B) were randomized: median age 35 years, 84% on antiretroviral therapy, median CD4 501 cells/mm3. In Arm A, 39 (27%) of women had bHSIL at entry, and in Arm B, 88 (62%) had abnormal cytology, 22 (15%) were diagnosed with bHSIL, 12 (8%) underwent LEEP. In follow-up, 30 (21%) and 31 (22%) developed bHSIL; time to bHSIL was similar between arms (P=.94). The prevalence of hrHPV at Month 6 was similar between arms (61% and 70%, P=.13). CONCLUSIONS HPV test-and-treat was not associated with improved bHSIL outcomes as compared to cytology-based screening. More effective treatment options are required to improve outcomes from screen-and-treat programs. CLINICAL TRIALS REGISTRATION NCT01315363.
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Affiliation(s)
- Timothy Wilkin
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Huichao Chen
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA
| | | | - Roy Matining
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Rosie Mngqibisa
- Durban International Clinical Research Site, Enhancing care Foundation, King Edward Hospital, Durban, South Africa
| | - Lameck Chinula
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | | | - Tsitsi Magure
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | | | - Mohammed Rassool
- Clinical HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Cynthia Riviere
- Clinical Research Department, Les Centres GHESKIO, Port-au-Prince, Haiti
| | - Rhamesh Bhosale
- Department of Obstetrics and Gynecology, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Sheela Godbole
- Division of Epidemiology, ICMR-National AIDS Research Unit, Pune, India
| | - Reena Naranjo
- Public Health & Scientific Research, Social & Scientific Systems, Inc, A DLH Holdings Company, Silver Spring, Maryland, USA
| | - Robert Coombs
- Departments of Laboratory Medicine & Pathology and Medicine, University of Washington, Seattle, Washington, USA
| | - Pamela Michelow
- National Health Laboratory Service, Johannesburg, South Africa
| | - Catherine Godfrey
- Office of the Global AIDS Coordinator, Department of State, Washington D.C., USA
| | - Cynthia Firnhaber
- Division of Infectious Disease, Department of Medicine, University of Colorado Medical School, Aurora, Colorado, USA
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Bensemmane S, Loayza Villarroel K, Montaño K, Louati E, Ascarrunz C, Rodriguez P, Fontaine V, Laokri S. Assessing Barriers Encountered by Women in Cervical Cancer Screening and Follow-Up Care in Urban Bolivia, Cochabamba. Healthcare (Basel) 2022; 10:healthcare10091604. [PMID: 36141216 PMCID: PMC9498362 DOI: 10.3390/healthcare10091604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Timely detection of cervical cells infected with high-risk human papillomavirus (HPV) improves cervical cancer prevention. In Bolivia, actual screening coverage only reaches 33.3% of the target population aged between 25 and 64 years despite free cytology screening. Furthermore, 50% to 80% screened women are lost during follow-up. This study aimed at identifying factors explaining this lack of follow-up care. Method: During the first phase, face-to-face semi-structured interviews were conducted with HPV-positive women. Secondly, we explored the reasons for the non-adherence to the follow-up care: knowledge, perceptions and beliefs about HPV, as well as barriers to healthcare access, using a structured survey on Cochabamba women and healthcare professionals. Results: Barriers to effective follow-up of the targeted populations were associated with health system shortcomings, including poor service delivery at the front- and second-line, health providers shortage, inadequate training, waiting time, high direct and indirect costs of care seeking and care, complex procedures to obtain HPV screening results and poor patient–provider communication. The follow-up was perceived as extremely stressful by the participants. Conclusion: Improved communication on HPV and HPV-related cancers in terms of representation in the general population and among the health professional’s population is vital to improve access for HPV infection follow-up care.
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Affiliation(s)
- Sherihane Bensemmane
- Ecole de Santé Publique, Université libre de Bruxelles (ULB), Route de Lennik, 1070 Brussels, Belgium
- Health Services Research, Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium
| | - Katherine Loayza Villarroel
- Ecole de Santé Publique, Université libre de Bruxelles (ULB), Route de Lennik, 1070 Brussels, Belgium
- Question Santé asbl, 1050 Brussels, Belgium
| | - Kevin Montaño
- Instituto de Investigacion en Ciencas Sociales INCISO, Universidad Mayor de San Simon (UMSS), Cochabamba, Bolivia
| | - Elyas Louati
- Faculté de Pharmacie, Université libre de Bruxelles (ULB), Campus Plaine, Boulevard du Triomphe, 1050 Brussels, Belgium
| | - Carla Ascarrunz
- Instituto de Investigacion en Ciencas Sociales INCISO, Universidad Mayor de San Simon (UMSS), Cochabamba, Bolivia
| | - Patricia Rodriguez
- Laboratorio de Virologia, Facultad de Medicina, UMSS, Cochabamba, Bolivia
| | - Véronique Fontaine
- Faculté de Pharmacie, Université libre de Bruxelles (ULB), Campus Plaine, Boulevard du Triomphe, 1050 Brussels, Belgium
- Correspondence: ; Tel.: +32-2-6505296
| | - Samia Laokri
- Faculté de Pharmacie, Université libre de Bruxelles (ULB), Campus Plaine, Boulevard du Triomphe, 1050 Brussels, Belgium
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, New Orleans, LA 70112, USA
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Adewumi K, Nishimura H, Oketch SY, Adsul P, Huchko M. Barriers and Facilitators to Cervical Cancer Screening in Western Kenya: a Qualitative Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1122-1128. [PMID: 33411253 PMCID: PMC9257902 DOI: 10.1007/s13187-020-01928-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2020] [Indexed: 06/12/2023]
Abstract
About nine out of 10 cervical cancer deaths occur in low-resource countries, with a particularly high burden in sub-Saharan Africa. The objectives of this study were to assess barriers and facilitators to cervical cancer screening in western Kenya from the perspectives of community members and healthcare providers. We conducted two focus groups with female community members (n = 24) and one with providers (n = 12) in Migori County, Kenya. Discussion guides queried about knowledge and awareness of cervical cancer prevention; structural, social, and personal barriers; and facilitators towards cervical cancer screening uptake. Group discussions were recorded, transcribed, and analyzed for emerging themes. Participants in both groups reported low awareness of HPV and cervical cancer screening in the community, and identified that as a main barrier to screening. Community members reported fear of pain and embarrassment as significant barriers to a screening pelvic exam. They also reported that providers' lack of knowledge and discomfort with a sensitive subject were significant barriers. A personal connection to cervical cancer and/or screening was associated with willingness to screen and awareness. Providers reported workload and lack of supplies and trained staff as significant barriers to offering services. Based on these findings, we identified three intervention components to address these facilitators and barriers to screening. They include utilizing existing social networks to expand awareness of cervical cancer risk and screening, training non-physician health workers to meet the demand for screening, and employing female-driven screening techniques such as self-collection of specimens for HPV testing. Cervical cancer prevention programs must take into account the local realities in which they occur. In low-resource areas in particular, identifying low-cost, effective, and culturally appropriate strategies for addressing poor screening uptake is important given limited funding. This study took a formative approach to identify facilitators and barriers to cervical cancer screening based on focus groups and interviews with community members and healthcare providers.
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Affiliation(s)
- Konyin Adewumi
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Holly Nishimura
- School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | - Sandra Y Oketch
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Prajakta Adsul
- National Cancer Institute/National Institutes of Health, Bethesda, MD, USA
| | - Megan Huchko
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
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Hategeka C, Adu P, Desloge A, Marten R, Shao R, Tian M, Wei T, Kruk ME. Implementation research on noncommunicable disease prevention and control interventions in low- and middle-income countries: A systematic review. PLoS Med 2022; 19:e1004055. [PMID: 35877677 PMCID: PMC9359585 DOI: 10.1371/journal.pmed.1004055] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 08/08/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While the evidence for the clinical effectiveness of most noncommunicable disease (NCD) prevention and treatment interventions is well established, care delivery models and means of scaling these up in a variety of resource-constrained health systems are not. The objective of this review was to synthesize evidence on the current state of implementation research on priority NCD prevention and control interventions provided by health systems in low- and middle-income countries (LMICs). METHODS AND FINDINGS On January 20, 2021, we searched MEDLINE and EMBASE databases from 1990 through 2020 to identify implementation research studies that focused on the World Health Organization (WHO) priority NCD prevention and control interventions targeting cardiovascular disease, cancer, diabetes, and chronic respiratory disease and provided within health systems in LMICs. Any empirical and peer-reviewed studies that focused on these interventions and reported implementation outcomes were eligible for inclusion. Given the focus on this review and the heterogeneity in aims and methodologies of included studies, risk of bias assessment to understand how effect size may have been compromised by bias is not applicable. We instead commented on the distribution of research designs and discussed about stronger/weaker designs. We synthesized extracted data using descriptive statistics and following the review protocol registered in PROSPERO (CRD42021252969). Of 9,683 potential studies and 7,419 unique records screened for inclusion, 222 eligible studies evaluated 265 priority NCD prevention and control interventions implemented in 62 countries (6% in low-income countries and 90% in middle-income countries). The number of studies published has been increasing over time. Nearly 40% of all the studies were on cervical cancer. With regards to intervention type, screening accounted for 49%, treatment for 39%, while prevention for 12% (with 80% of the latter focusing on prevention of the NCD behavior risk factors). Feasibility (38%) was the most studied implementation outcome followed by adoption (23%); few studies addressed sustainability. The implementation strategies were not specified well enough. Most studies used quantitative methods (86%). The weakest study design, preexperimental, and the strongest study design, experimental, were respectively employed in 25% and 24% of included studies. Approximately 72% of studies reported funding, with international funding being the predominant source. The majority of studies were proof of concept or pilot (88%) and targeted the micro level of health system (79%). Less than 5% of studies report using implementation research framework. CONCLUSIONS Despite growth in implementation research on NCDs in LMICs, we found major gaps in the science. Future studies should prioritize implementation at scale, target higher levels health systems (meso and macro levels), and test sustainability of NCD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.
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Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Prince Adu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allissa Desloge
- School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Robert Marten
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | | | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Ting Wei
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
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Hariprasad R, Mittal S, Basu P. Role of colposcopy in the management of women with abnormal cytology. Cytojournal 2022; 19:40. [PMID: 35928528 PMCID: PMC9345135 DOI: 10.25259/cmas_03_15_2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 11/04/2022] Open
Abstract
Cytology identifies the women who are at higher risk of harboring high-grade cervical premalignant lesions or invasive cancer. However, a diagnostic test such as colposcopy is crucial for women with abnormal cytology for localization of the abnormality, confirmation of diagnosis, and appropriate management. To standardize this subjective technique and to minimize the interobserver variations, Swede scoring system was introduced. The revised colposcopic nomenclature of the International Federation of Cervical Pathology and Colposcopy in 2011 included various normal and abnormal colposcopic findings and gives a description of colposcopic features which improves its accuracy over the colposcopic indices. There is consensus agreement that cytology indicative of high-grade lesions (ASC-H and HSIL in the Bethesda system) should engender immediate referral for colposcopy and biopsy. The management of women who have equivocal or borderline cytology of low-grade abnormalities (ASCUS/LSIL) is still under deliberation. It is generally agreed to have an HPV triage for women with equivocal cytology. Based on the latest recommendations, the current chapter provides an extensive overview of the role of colposcopy in the management of women with various abnormalities reported on Pap smear.
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Affiliation(s)
- Roopa Hariprasad
- Department of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Srabani Mittal
- Department of Preventive Oncology, Cancer Foundation of India, Principal investigator/BMGF Project, Child in Need Institute, Kolkata, India
| | - Partha Basu
- International Agency for Research on Cancer, World Health Organization, Lyon, France
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12
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Prabhu M, Riley LE. Challenges in Interpreting the Ob/Gyn Literature: Studies of Screening. Clin Obstet Gynecol 2022; 65:244-251. [PMID: 35354158 DOI: 10.1097/grf.0000000000000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Screening tests are critical to patient care. Screening tests must meet ten criteria established by the World Health Organization in order to be considered effective. Common types of studies on screening tests include those that establish test characteristics, such as sensitivity, specificity, positive predictive value, and negative predictive value, as well as cost-effective analyses. In this paper, we review the criteria for effective screening tests, and discuss the strengths and pitfalls of common study designs evaluating screening tests.
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Affiliation(s)
- Malavika Prabhu
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York
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13
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Verma ML, Singh U, Kumari R, Sachan R, Sankhwar PL, Solanki V. Randomized controlled study for comparison of efficacy and safety between thermocoagulation and cryotherapy in visual inspection with acetic acid positive cervical lesions. J Cancer Res Ther 2022; 18:603-611. [PMID: 35900529 DOI: 10.4103/jcrt.jcrt_832_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Less literature is available on the performance of thermocoagulation for treatment of premalignant cervical lesions and its comparison with cryotherapy from low- and middle-income countries like India. Materials and Methods : A prospective randomized controlled study was done in the Department of Obstetrics and Gynecology from August 2018 to September 2019 after obtaining ethical clearance from Institutional Review Board (Reg no: ECR/262/Inst/Up/2013/RR/16) Ref no: 278/Ethics/R. cell-18). A total of 68 women with Visual inspection with acetic acid (VIA) positive cervical lesion were randomized into two groups. Group A was treated with cryotherapy and Group B was treated with thermocoagulation. Estimates of cure, adverse effects or complications were presented as frequencies, percentages, and mean ± standard deviation. Results Out of 667 patients, 624 patients underwent VIA testing among which 68 were VIA positive (10.89%, 68/624). The efficacy of thermocoagulation was 93.54% and that of cryotherapy was 90.32%. Immediate side effects were significantly lesser in thermocoagulation group (P = 0.008) in comparison to cryotherapy. Conclusion Thermocoagulation is better treatment modality than cryotherapy for VIA-positive cervical lesions may not be in terms of efficacy but definitely in terms of patient comfort and safety.
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Affiliation(s)
- Manju Lata Verma
- Department of Obstetrics and Gynaecology, KGMU, Lucknow, Uttar Pradesh, India
| | - Uma Singh
- Department of Obstetrics and Gynaecology, KGMU, Lucknow, Uttar Pradesh, India
| | - Ruby Kumari
- Department of Obstetrics and Gynaecology, KGMU, Lucknow, Uttar Pradesh, India
| | - Rekha Sachan
- Department of Obstetrics and Gynaecology, KGMU, Lucknow, Uttar Pradesh, India
| | - Pushp Lata Sankhwar
- Department of Obstetrics and Gynaecology, KGMU, Lucknow, Uttar Pradesh, India
| | - Vandana Solanki
- Department of Obstetrics and Gynaecology, KGMU, Lucknow, Uttar Pradesh, India
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Banerjee D, Mittal S, Mandal R, Basu P. Screening technologies for cervical cancer: Overview. Cytojournal 2022; 19:23. [PMID: 35510117 PMCID: PMC9063504 DOI: 10.25259/cmas_03_04_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Ever since the introduction of the Papanicolaou (PAP) smear test was published in 1941 in American Journal of Obstetrics and Gynecology, PAP test linked with definitive treatment has prevented millions of women from cervical cancer in the developed countries. Due to limited availability of resources, a lack of infrastructure and difficulty in getting highly trained professionals, widespread implementation of PAP test dependent cervical cancer screening program has not been established in low and middle income countries such as India. Therefore, after availability of non-cytological tests such as visual inspection on acetic acid (VIA) and human papillomavirus (HPV) DNA test, there is a paradigm shift in cervical cancer screening methods. In past two decades, various research work has convincingly established the utility of VIA and HPV test in developing countries. The evidences were evaluated by the World Health Organization (WHO) and recommendations have been recently published for comprehensive cervical cancer control strategies for the low and middle income countries. For any successful screening program, achieving high coverage (>70%) of the target population rather than frequent screening is the most important determinant. It is also equally important to ensure appropriate investigations of the screen positive women to establish the disease and treatment of the screen detected cases of cervical intra epithelial neoplasia (CIN) and cancer. HPV testing is the WHO recommended test for cervical cancer screening especially in view of widespread HPV vaccination in young population leading to lower prevalence of CIN and other HPV related diseases.
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Affiliation(s)
- Dipanwita Banerjee
- Department of Gynaecological Oncology, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | | | - Ranajit Mandal
- Department of Gynaecological Oncology, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Partha Basu
- Early Detection and Prevention Section/Screening Group, International Agency for Research on Cancer, Lyon, France
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15
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Soler M, Masch R, Saidu R, Cremer M. Thermal Ablation Treatment for Cervical Precancer (Cervical Intraepithelial Neoplasia Grade 2 or Higher [CIN2+]). Methods Mol Biol 2022; 2394:867-882. [PMID: 35094363 DOI: 10.1007/978-1-0716-1811-0_46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cervical cancer is a leading cause of mortality for women in low- and middle-income countries (LMICs). Invasive disease can be prevented through the treatment of high-grade cervical precancer lesions. Types of treatment for cervical precancer include excisional procedures that surgically remove the affected tissue and ablation treatments which utilize extreme temperatures to destroy precancerous cells. Excision is the first-line treatment in higher income countries, but requires specialized training and equipment that make it unsuitable for low-income settings. The most common treatment globally is cryotherapy, which utilizes cryogenic gas to freeze the area. However, the need for gas presents significant procurement and logistical challenges. The World Health Organization (WHO) has recently endorsed the use of thermal ablation, a method that utilizes heat to destroy precancerous tissue. This review describes three existing thermal ablation devices and protocols for their use, including step-by-step instruction guides to perform a successful treatment with each device and observations specific to each machine.
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Affiliation(s)
- Montserrat Soler
- Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
- Basic Health International, Pittsburgh, PA, USA.
| | | | - Rakiya Saidu
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| | - Miriam Cremer
- Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
- Basic Health International, Pittsburgh, PA, USA
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Safoorah A, Kanagal D, D'Cunha P. Colposcopic analysis of cervical lesions using popular scoring systems: Reid versus Swede. Arch Gynecol Obstet 2021; 304:1253-1258. [PMID: 34432109 DOI: 10.1007/s00404-021-06184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess the effectiveness of colposcopy in detecting cervical lesions and to grade them according to Reid score and Swede score, and compare it with histopathology results. METHODS This study was conducted on 130 patients in a tertiary care centre, who were subjected to pap smear and colposcopy. The cervical lesions were graded according to Reid score and Swede score, and a biopsy was obtained from the lesion. Histopathology results were correlated with colposcopy findings, and the scores were compared. RESULTS The colposcopic findings using Reid score and Swede score correlated with histopathology results in the study population. The association between colposcopic impression and histopathology result was highly significant (p < 0.001), using both Reid score and Swede score. The sensitivity, specificity, PPV and NPV of Reid score (overall) was 86.2%, 80.20%, 55.56% and 95.3%, respectively. The diagnostic accuracy was 81.54%. At score > 5, specificity increased to 99% and diagnostic accuracy was 92.31%. The overall sensitivity, specificity, PPV, NPV and diagnostic accuracy of Swede score was 89.7%, 49.5%, 33.8%, 94.3% and 48.46%, respectively. As the cut off value increased, the sensitivity decreased. But the specificity, PPV, NPV and diagnostic accuracy increased and was statistically significant. The specificity and PPV was 100% at score > 8. CONCLUSION As the cut off value increased, the diagnostic accuracy of both the Scores increased, and was more accurate in detecting high-grade lesions.
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Affiliation(s)
- Ayshath Safoorah
- Department of Obstetrics and Gynecology, Yenepoya Medical College Hospital, Mangalore, Karnataka, India.
| | - Deepa Kanagal
- Department of Obstetrics and Gynecology, Father Muller Medical College Hospital, Mangalore, Karnataka, India
| | - Prema D'Cunha
- Department of Obstetrics and Gynecology, Father Muller Medical College Hospital, Mangalore, Karnataka, India
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Mungo C, Osongo CO, Ambaka J, Randa MA, Omoto J, Cohen CR, Huchko M. Safety and Acceptability of Thermal Ablation for Treatment of Human Papillomavirus Among Women Living With HIV in Western Kenya. JCO Glob Oncol 2021; 6:1024-1033. [PMID: 32634066 PMCID: PMC7392781 DOI: 10.1200/go.20.00035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The WHO now recommends thermal ablation as an alternative to cryotherapy within “screen-and-treat” cervical cancer programs in low- and middle-income countries (LMICs). We conducted a safety and acceptability clinical trial of thermal ablation in a Kenyan Ministry of Health hospital among women living with HIV (WLWH; ClinicalTrials.gov identifier: NCT04191967). METHODS Between August 2019 and February 2020, WLWH age 25-65 years underwent human papillomavirus (HPV) self-collection in western Kenya. HPV-positive women underwent visual inspection with acetic acid, biopsy, and treatment with thermal ablation performed by a nonphysician clinician, if eligible by standard guidelines. A questionnaire was administered after treatment to assess for pain and treatment acceptability. Adverse events (AEs) were evaluated 4-6 weeks after treatment with a standardized grading tool. RESULTS A total of 293 HPV-positive WLWH underwent thermal ablation in the study period. The mean age was 40.4 years (standard deviation, 8.7 years). After treatment, 15 (5.1%), 231 (78.8%), 42 (14.3%), and 5 (1.8%) reported none, mild, moderate, and severe pain with treatment, respectively. At follow-up, spotting, vaginal discharge, and pelvic pain were reported by 99 (37.8%), 258 (98.5%), and 46 (17.6%), respectively, for a median of 3.3 (interquartile range [IQR], 2-3), 14 (IQR, 7-21), and 7 (IQR, 3-7) days, respectively. Most participants graded their AEs as mild (grade 1): 94 (95.0%) for bleeding, 125 (48.5%) for vaginal discharge, and 37 (80.4%) for pelvic pain. No grade 3 or 4 AEs were reported. The vast majority (99.2%) were satisfied with the treatment and would recommend it to a friend. CONCLUSION Thermal ablation performed by nonphysicians in the public health sector in Kenya proved safe and highly acceptable in treating HPV-positive WLWH.
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Affiliation(s)
- Chemtai Mungo
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA
| | | | | | | | - Jackton Omoto
- Department of Obstetrics and Gynecology, Maseno University School of Medicine, Kisumu, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Megan Huchko
- Department of Obstetrics and Gynecology, Duke University, Durham, NC
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18
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Comparison Between Modified Reid Index and Swede Score in Visual Inspection by Acetic Acid (VIA)-Positive Women Suspected of Cervical Cancer. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Agah J, Sharifzadeh M, Hosseinzadeh A. Cryotherapy as a Method for Relieving Symptoms of Cervical Ectopy: A Randomized Clinical Trial. Oman Med J 2019; 34:322-326. [PMID: 31360321 PMCID: PMC6642705 DOI: 10.5001/omj.2019.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objectives Benign cervical ectopy (CE) may cause chronic or recurrent symptoms leading to women repeatedly being referred to gynecology clinics. We aimed to present a safe and effective method for relieving symptoms of CE. Methods This double-blind clinical trial was conducted among 164 women with CE who complained of persistent or recurrent symptoms of cervicitis in the last six months. Patient’s demographic data, medical history, symptoms, and vaginal examination results were recorded. Normal co-test or Pap smear was required to enter the study. Participants were divided into two groups; the intervention group received cryotherapy and the control group underwent cryo-placebo (inserted the probe without true cryotherapy). The outcomes including improvement of symptoms and CE were monitored one, three, and six months later. Results The prevalence of symptoms in the two groups were not significantly different (p > 0.050). Symptom improvement was significantly higher with cryotherapy: vaginal discharge (p = 0.006), itching (p < 0.001), dyspareunia (p = 0.005), post-coital bleeding (p = 0.023), and pelvic pain (p = 0.009). If the symptoms did not disappear, their severity was lower after cryotherapy, comparatively (p < 0.050). Examination showed more improvement of CE following cryotherapy (p < 0.001). Cryotherapy showed no remarkable side effects and was associated with more satisfaction (p < 0.001). Conclusions Cryotherapy is a safe, effective, fast-acting, and cost-benefit therapy that can be considered for the treatment of symptomatic CE.
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Affiliation(s)
- Jila Agah
- Department of Obstetrics and Gynecology Oncology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Masoumeh Sharifzadeh
- Department of Midwifery, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Ali Hosseinzadeh
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Dayal U, Gupta B, Hariprasad R, Shriya R, Rajaram S, Prasad B, Mehrotra R. Comparison of the AV Magnivisualizer device with colposcopy to detect cervical intraepithelial neoplasia using the Swede scoring system. Int J Gynaecol Obstet 2019; 147:219-224. [PMID: 31353466 DOI: 10.1002/ijgo.12931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/10/2019] [Accepted: 07/26/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the AV Magnivisualizer with colposcopy to detect cervical intraepithelial neoplasia (CIN) using the Swede scoring system. METHODS Cross-sectional study conducted in a tertiary care hospital from May 2017 to March 2018. One hundred women with positive results at visual inspection with acetic acid underwent cervical inspection using the Magnivisualizer followed by a colposcope. Biopsies were taken if the Swede score was greater than 4. Pregnant women, women with an obvious cervical growth, acute cervicitis, or prior cervical surgery were excluded. Diagnostic accuracy of the Magnivisualizer and colposcope was calculated for high-grade lesions (CIN 2/CIN 2+) and agreement was compared between the two modalities. RESULTS The sensitivity, specificity, and positive and negative predictive values of the Magnivisualizer were 88.2%, 70.0%, 50.0%, and 94.6%, respectively, to detect high-grade lesions at a Swede score cutoff of 5 or more. The area under the curve for the Magnivisualizer was 0.80 (95% CI, 0.67-0.92), which was comparable with colposcopy (AUC 0.86; 95% CI, 0.76-0.96). There was very good agreement between the Magnivisualizer and colposcopy (κ=0.865, P<0.001) for high-grade lesions. CONCLUSION The Magnivisualizer had high diagnostic accuracy to detect high-grade CIN in screen-positive women, which was comparable with colposcopy.
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Affiliation(s)
- Utkarsh Dayal
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Bindiya Gupta
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Roopa Hariprasad
- National Institute of Cancer Prevention and Research, Noida, India
| | - Rashmi Shriya
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Shalini Rajaram
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Bhavya Prasad
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Ravi Mehrotra
- National Institute of Cancer Prevention and Research, Noida, India
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de Fouw M, Oosting RM, Rutgrink A, Dekkers OM, Peters AAW, Beltman JJ. A systematic review and meta-analysis of thermal coagulation compared with cryotherapy to treat precancerous cervical lesions in low- and middle-income countries. Int J Gynaecol Obstet 2019; 147:4-18. [PMID: 31273785 DOI: 10.1002/ijgo.12904] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 05/09/2019] [Accepted: 07/03/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Thermal coagulation is gaining popularity for treating cervical intraepithelial neoplasia (CIN) in screening programs in low- and middle-income countries (LMICs) due to unavailability of cryotherapy. OBJECTIVES Assess the effectiveness of thermal coagulation for treatment of CIN lesions compared with cryotherapy, with a focus on LMICs. SEARCH STRATEGY Papers were identified from previous reviews and electronic literature search in February 2018 with publication date after 2010. SELECTION CRITERIA Publications with original data evaluating cryotherapy or thermal coagulation with proportion of cure as outcome, assessed by colposcopy, biopsy, cytology, and/or visual inspection with acetic acid (VIA), and minimum 6 months follow-up. DATA COLLECTION AND ANALYSIS Pooled proportions of cure are presented stratified per treatment modality, type of lesion, and region. MAIN RESULTS Pooled cure proportions for cryotherapy and thermal coagulation, respectively, were 93.8% (95% CI, 88.5-97.7) and 91.4% (95% CI, 84.9-96.4) for CIN 1; 82.6% (95% CI, 77.4-87.3) and 91.6% (95% CI, 88.2-94.5) for CIN 2-3; and 92.8% (95% CI, 85.6-97.7) and 90.1% (95% CI, 87.0-92.8) for VIA-positive lesions. For thermal coagulation of CIN 2-3 lesions in LMICs 82.4% (95% CI, 75.4-88.6). CONCLUSIONS Both cryotherapy and thermal coagulation are effective treatment modalities for CIN lesions in LMICs.
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Affiliation(s)
- Marlieke de Fouw
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Leiden, Netherlands
| | - Roos Marieke Oosting
- Department of BioMechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Amy Rutgrink
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Leiden, Netherlands
| | - Olaf Matthijs Dekkers
- Department of Clinical Epidemiology and Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Jogchum Jan Beltman
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Leiden, Netherlands
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Reimbursement Incentives to Improve Adherence to Follow-Up of Cervical Cancer Cytology Screening Results in Peru. J Low Genit Tract Dis 2019; 23:116-123. [PMID: 30741754 DOI: 10.1097/lgt.0000000000000459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine Peruvian women's attitudes toward novel reimbursement incentives used to improve adherence to obtaining cervical cytology test results. MATERIALS AND METHODS Women presenting for cervical cancer screening in Peru completed a 34-item Investigational Review Board-approved questionnaire. The questionnaire determined their attitudes toward various reimbursement incentives to improve adherence to obtaining cervical cytology results. Descriptive statistics, generalized linear models, and Kruskal-Wallis tests were used in the analyses. RESULTS Completed questionnaires were available for 997 women. Most women (51%) would be more likely to return for their Pap result if an incentive was provided, 79% (759/956) agreed that they would pay for the Pap test, and 51% (402/859) would be willing to pay 10 Soles or less. Quechua-speaking women considered follow-up more difficult (p < .0001) but were less likely to return for their Pap results (p < .0001), pay for the Pap test (p < .0001), and afford paying more than 5 Soles (p < .0001) than women who spoke Spanish or both languages. More women who earn 1000 Soles/year or less would likely return if incentivized (p < .0001), felt the incentive would help them remember to return (p = .0047), and would be willing to pay whether there was a rebate (p = .010) as compared with women earning more money. CONCLUSIONS A reimbursement incentive program designed to improve follow-up of cervical cytology test results was acceptable to most Peruvian women. Such a behavioral-modifying program may improve patient follow-up after cervical cytology testing. Implementation may reduce the morbidity and mortality of cervical cancer in remote regions of the country.
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Pfaff C, Singano V, Akello H, Amberbir A, Berman J, Kwekwesa A, Matengeni A, Banda V, Msonko J, Speight C, Kabeya BM, van Oosterhout JJ. Early experiences in integrating cervical cancer screening and treatment into HIV services in Zomba Central Hospital, Malawi. Malawi Med J 2019; 30:211-214. [PMID: 30627358 PMCID: PMC6307048 DOI: 10.4314/mmj.v30i3.14] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Malawi has the highest rate of cervical cancer globally and cervical cancer is six to eight times more common in women with HIV. HIV programmes provide an ideal setting to integrate cervical cancer screening. Methods Tisungane HIV clinic at Zomba Central Hospital has around 3,700 adult women receiving treatment. In October 2015, a model of integrated cervical cancer screening using visual inspection with acetic acid (VIA) was adopted. All women aged 20 and above in the HIV clinic were asked if they had cervical cancer screening in the past three years and, if not, were referred for screening. Screening was done daily by nurses in a room adjacent to the HIV clinic. Cold coagulation was used to treat pre-cancerous lesions. From October 2016, a modification to the HIV programme's electronic medical record was developed that assisted in matching numbers of women sent for screening with daily screening capacity and alerted providers to women with pre-cancerous lesions who missed referrals or treatment. Results Between May 2016 and March 2017, cervical cancer screening was performed in 957 women from the HIV clinic. Of the 686 (71%) women who underwent first ever screening, 23 (3.4%) were found to have VIA positive lesions suggestive of pre-cancer, of whom 8 (35%) had a same-day cold coagulation procedure, seven (30%) deferred cold coagulation to a later date (of whom 4 came for treatment), and 8 (35%) were referred to surgery due to size of lesion; 5/686 (0.7%) women had lesions suspicious of cancer. Conclusion Incorporating cervical cancer screening into services at HIV clinics is feasible. A structured approach to screening in the HIV clinic was important.
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Affiliation(s)
- Colin Pfaff
- Dignitas International, Zomba, Malawi.,Department of Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | | | | | | | | | | | | | | | | | - Biselele M Kabeya
- Department of Obstetrics and Gynaecology, Zomba Central Hospital, Zomba, Malawi
| | - Joep J van Oosterhout
- Dignitas International, Zomba, Malawi.,Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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Paluku JL, Carter TE, Lee M, Bartels SA. Massive single visit cervical pre-cancer and cancer screening in eastern Democratic Republic of Congo. BMC Womens Health 2019; 19:43. [PMID: 30832697 PMCID: PMC6399865 DOI: 10.1186/s12905-019-0737-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 02/20/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In the Democratic Republic of Congo (DRC), practical and affordable strategies for cervical cancer screening are needed to detect and treat pre-cancerous and cancerous lesions in a timely fashion. This study presents the results of mass cervical cancer screenings in eastern DRC using a "screen and treat" approach. METHODS In two mass cervical cancer screening campaigns, patients underwent a combination of visual inspection of the cervix with acetic acid, visual inspection of the cervix with Lugol iodine solution, and colposcopy with or without loop electrosurgical excision procedure. Cervical biopsy samples were taken for histology analysis. Marital status, age, history of abnormal bleeding, and number of pregnancies were recorded for each patient and association analyses were performed. RESULTS Of the 644 women who received cervical pre-cancer and cancer screening, 48 had suspicious pre-cancer and cancer lesions that were biopsied (7.45%). On histology analysis cervical intraepithelial neoplasia (CIN) was identified in 15 (2.33%), squamous cell carcinoma (SCC) was identified in 6 (0.93%) and non-neoplastic cervicitis was identified in 11 (1.71%). Abnormal bleeding was significantly associated with CIN/SCC but no significant association was observed for prior pregnancy, patients' home region, or age. CONCLUSION Forty-eight women with suspicious pre-cancerous or cancerous lesions were successfully identified using the "screen and treat" approach in eastern DRC, suggesting that this approach is feasible for reducing cervical cancer morbidity and mortality. However, community awareness would be necessary, providers would have to be properly trained, referral and follow up mechanisms would have to be put in place, and equipment / supplies would have to be secured if the "screen and treat" approach is to be successful on a wider scale. There is ongoing need for HPV vaccination in DRC as a primary prevention strategy against cervical cancer.
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Affiliation(s)
| | - Tamar E Carter
- Bioinformatics and Genomics Department, University of North Carolina, Charlotte, USA
- Department of Biology, Baylor University, Waco, TX, USA
| | | | - Susan A Bartels
- Departments of Emergency Medicine and Public Health Sciences, Queen's University, Kingston, Canada
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Huchko MJ, Kahn JG, Smith JS, Hiatt RA, Cohen CR, Bukusi E. Study protocol for a cluster-randomized trial to compare human papillomavirus based cervical cancer screening in community-health campaigns versus health facilities in western Kenya. BMC Cancer 2017; 17:826. [PMID: 29207966 PMCID: PMC5717798 DOI: 10.1186/s12885-017-3818-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite guidelines for cervical cancer prevention in low-resource countries, a very small proportion of women in these settings undergo screening, and even fewer women are successfully treated. Using pilot data from western Kenya and World Health Organization recommendations, we developed a protocol to implement evidence-based cervical cancer screening and linkage to treatment strategies to the rural communities. We describe the protocol for a cluster-randomized trial to compare two implementation strategies for human-papillomavirus (HPV)-based cervical cancer screening program using metrics described in the RE-AIM (reach, efficacy, adaption, implementation and maintenance) framework. METHODS The study is a three-year, two-phase cluster-randomized trial in 18 communities in western Kenya. During Phase 1, six control communities were offered screening in health facilities; and six intervention communities were offered screening in community health campaigns. Screening was done with human-papillomavirus testing through self-collected specimens. Phase 1 ended and we are working in partnership with communities to further contextualize the implementation strategy for screening, and develop an enhanced linkage to treatment plan. This plan will be tested in an additional six communities in Phase 2 (enhanced intervention). We will compare the reach, efficacy, cost-effectiveness and adaptability of the implementation strategies. DISCUSSION Effective low-cost cervical cancer prevention technologies are becoming more widely available in low- and middle-income countries. Despite increasing government support for cervical cancer prevention, there remains a sizeable gap in service availability. We will use implementation science to identify the most effective strategies to fill this gap through development of context-specific evidence-based solutions. This protocol design and results can help guide implementation of cervical cancer screening in similar settings, where women are most underserved and at highest risk for disease. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov , NCT02124252 .
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Affiliation(s)
- Megan J Huchko
- Duke University, Global Health Institute and Department of Obstetrics and Gynecology, 310 Trent Drive, Room 204, Durham, NC, 27708, USA.
| | - James G Kahn
- Department of Epidemiology and Biostatistics, University of California San Francisco, Box 0560, San Francisco, CA, 94143-0560, USA
| | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina, 2103 McGavran-Greenberg Hall Campus, Box# 7435, Chapel Hill, NC, 27599-7435, USA
| | - Robert A Hiatt
- Department of Epidemiology and Biostatistics, University of California San Francisco, Box 0560, San Francisco, CA, 94143-0560, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, Box 1280, 560 Mission Street, 3rd Floor, San Francisco, CA, 94143, USA
| | - Elizabeth Bukusi
- Kenya Medical Research Institute, Center for Microbiology Research, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya.,Department of Obstetrics and Gynecology, University of Nairobi, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
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Julião I, Savva-Bordalo J, Lunet N. Cervical cancer screening opportunities for Guinea-Bissau. Porto Biomed J 2017; 2:306-310. [PMID: 32258787 PMCID: PMC6806762 DOI: 10.1016/j.pbj.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/13/2017] [Indexed: 12/21/2022] Open
Abstract
Guinea-Bissau is a severely resource constrained country, in search of political stability and development in every sector of public life. International aid is permanent and healthcare is one of the most targeted fields, focusing mostly on infectious diseases, maternity, infant malnutrition, access to healthcare and gender inequality in health. As in the rest of Sub-Saharan Africa, cervical cancer is gathering increasing attention from the community and ruling officers. The potential of screening for control of cervical cancer raised the interest of adapting screening methods to low-resource settings. This started the search for the best resource-adapted strategies, which promoted several trials that currently shape the development of screening programs in these countries. Prevention and control strategies are also being adapted taking into account the availability of human Papillomavirus vaccination. Nonetheless, several barriers are still in place for widespread vaccination programs, and cervical cancer screening and treatment remain central in the control of cervical cancer in low-resource settings. We intend to discuss current cervical cancer screening approaches in low-resource countries and opportunities for their implementation in Guinea-Bissau.
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Affiliation(s)
- Ivo Julião
- Instituto Português de Oncologia do Porto, Porto, Portugal
| | | | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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Fokom Domgue J, Valea FA. Is It Relevant to Keep Advocating Visual Inspection of the Cervix With Acetic Acid for Primary Cervical Cancer Screening in Limited-Resource Settings? J Glob Oncol 2017; 4:1-5. [PMID: 30241142 PMCID: PMC6180765 DOI: 10.1200/jgo.17.00048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Joel Fokom Domgue
- Joel Fokom Domgue,University Hospital Centre, Yaounde, Cameroon, and National Cancer Institute, Rockville, MD; and
| | - Fidel A Valea
- Fidel A. Valea, Virginia Tech Carilion School of Medicine, Roanoke, VA
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Jahic M, Jahic E, Mulavdic M, Hadzimehmedovic A. Difference Between Cryotherapy and Follow Up Low Grade Squamous Lesion of Cervix Uteri. Med Arch 2017; 71:280-283. [PMID: 28974850 PMCID: PMC5585814 DOI: 10.5455/medarh.2017.71.280-283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/05/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cervical cancer can be successfully prevented by effective treatment. AIM Analyse of success of cryotherapy in LSIL and ASCUS. MATERIALS ET METHODS In retrospective study between January 2016 to March 2017, 3244 PAP test were analysed. 257 patients who had been diagnosed with LSIL and ASCUS from PAP smear were divided in two groups: women who had HPV positive, colposcopic positive and cytologic finding of LSIL or ASCUS treathed with cryotherapy and women with LSIL, ASCUS and negative colposcopy. χ2 test was used for statistical analysis of data. RESULTS Analysis of 3244 PAP smears showed negative for intraepithelial lesion or malignancy (NILM) in 90,10% (N-2923), and abnormal in 9,8% (N-321) of women. ASCUS was found in 4,8% (N-156) and ASC-H in 0,2% (N-6), LSIL in 3,1% (N-101), HSIL in 0,64% (N-21). The average age of patients with ASCUS lesion was 41 ± 12 years. After cryotherapy, HSIL had progression in 1,5% (N-1), persistence in 6,3% (N-4) and regression in 91,7% (N-58). Progression occured in 10,5% (N-4) of HSIL, persistence in 52,6% (N-20) and regression in 36,7% (N-14) in 38 women with LSIL lesion after repeated PAP test. Progression occured in 8% (N-10) of LSIL and 4% HSIL (N-5), persistence in 58% (N-72) and regression in 29,8% (N-37) in 124 women with ASCUS lesion after treatment and repeated PAP test. Difference in progression lesions in HSIL between women with cryotherapy (1,5%) and follow-up (10,5%) after LSIL is not significant, but progression to CIN II occured after cryotherapy. CIN III or cervical cancer was not found. CONCLUSION Cryotherapy prevents progression of LSIL in HSIL and in cervical cancer. Because of that cryotherapy is successful method in prevention of cervical cancer.
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Affiliation(s)
- Mahira Jahic
- Private Gynecology Ordination, Dr Mahira Jahic” Tuzla, Tuzla, Bosnia and Herzegovina
- University of Tuzla, Faculty of Medicine Tuzla, Tuzla, Tuzla, Bosnia and Herzegovina
| | - Elmir Jahic
- Private Gynecology Ordination, Dr Mahira Jahic” Tuzla, Tuzla, Bosnia and Herzegovina
- Cardiovascular Clinic, University Clinical Centar Tuzla, Tuzla, Tuzla, Bosnia and Herzegovina
| | - Mirsada Mulavdic
- University of Tuzla, Faculty of Medicine Tuzla, Tuzla, Tuzla, Bosnia and Herzegovina
- Polyclinic of Laboratory diagnostic, Department of Microbiology, University Clinical Centar Tuzla, Tuzla, Tuzla, Bosnia and Herzegovina
| | - Azra Hadzimehmedovic
- University of Tuzla, Faculty of Medicine Tuzla, Tuzla, Tuzla, Bosnia and Herzegovina
- Clinic for Gynecology and Obctetrics, University Clinical Centar Tuzla, Tuzla, Tuzla, Bosnia and Herzegovina
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Implementing community-based cervical cancer screening programs using visual inspection with acetic acid in India: A systematic review. Cancer Epidemiol 2017; 49:161-174. [PMID: 28704717 DOI: 10.1016/j.canep.2017.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 11/20/2022]
Abstract
The objective of this review was to systematically appraise the existing published literature about community-based cervical cancer screening programs that have used visual inspection methods using acetic acid (VIA) in India. All peer reviewed journal articles till December 2015 were searched per PRISMA guidelines. Articles reporting results from cervical cancer screening programs in community-based settings, conducted in India, and using VIA were included in this review. The search resulted in 20 articles to be included in the review with a total of 313,553 women at 12 unique urban and rural sites across India. Seventeen (85%) studies were cross-sectional and three studies were randomized controlled trials; most studies compared accuracy of VIA with other screening tests such as visual inspection using Lugol's Iodine (VILI), HPV DNA, and cytology. Of studies that reported test accuracy for CIN Grade 2+, the VIA sensitivity values ranged from 16.6-82.6% and specificity ranged from 82.1-96.8%. Women between age groups of 30-59 years were recruited using motivational one-on-one counseling and local support staff. All studies conducted diagnostic follow-up using colposcopy and guided biopsies, when necessary. Three major themes were identified that facilitated implementation of screening programs in a community-based setting: standardized training that maintained competency of test providers; collaborations with community-based organizations that used health education for recruitment of participants; and employing the screen-and-treat method to reduce loss to follow-up. Summarized evidence presented in this review could substantially influence future implementation and sustainment of cervical cancer screening programs at a national level.
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Basu P, Meheus F, Chami Y, Hariprasad R, Zhao F, Sankaranarayanan R. Management algorithms for cervical cancer screening and precancer treatment for resource-limited settings. Int J Gynaecol Obstet 2017; 138 Suppl 1:26-32. [PMID: 28691336 DOI: 10.1002/ijgo.12183] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Management algorithms for screen-positive women in cervical cancer prevention programs have undergone substantial changes in recent years. The WHO strongly recommends human papillomavirus (HPV) testing for primary screening, if affordable, or if not, then visual inspection with acetic acid (VIA), and promotes treatment directly following screening through the screen-and-treat approach (one or two clinic visits). While VIA-positive women can be offered immediate ablative treatment based on certain eligibility criteria, HPV-positive women need to undergo subsequent VIA to determine their eligibility. Simpler ablative methods of treatment such as cryotherapy and thermal coagulation have been demonstrated to be effective and to have excellent safety profiles, and these have become integral parts of new management algorithms. The challenges faced by low-resource countries are many and include, from the management perspective, identifying an affordable point-of-care HPV detection test, minimizing over-treatment, and installing an effective information system to ensure high compliance to treatment and follow-up.
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Affiliation(s)
- Partha Basu
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Filip Meheus
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Youssef Chami
- Lalla Salma Foundation for Cancer Prevention and Treatment, Rabat, Morocco
| | - Roopa Hariprasad
- Division of Clinical Oncology, National Institute of Cancer Prevention and Research (ICMR), Noida, India
| | - Fanghui Zhao
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rengaswamy Sankaranarayanan
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
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Dumont A, Bessières N, Benbassa A, Razafindrafara G, Rabearison F, Philippe HJ. Dépistage du cancer du col utérin en milieu rural à Madagascar : faisabilité, couverture et incidence. J Gynecol Obstet Hum Reprod 2017. [DOI: 10.1016/j.jogoh.2017.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Use of visual inspection with acetic acid, Pap smear, or high-risk human papillomavirus testing in women living with HIV/AIDS for posttreatment cervical cancer screening: same tests, different priorities. AIDS 2017; 31:233-240. [PMID: 28002084 DOI: 10.1097/qad.0000000000001327] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Few studies have addressed optimal follow-up for HIV-infected women after cervical treatment. This study aimed to compare performance of three available tests to detect posttreatment cervical disease in HIV-infected women in Kenya. DESIGN This is a prospective cohort study. METHODS At least 6 months following cryotherapy, 517 HIV-infected women were evaluated concurrently with visual inspection with acetic acid (VIA), papanicolaou (Pap) smear, and high-risk human papillomavirus (HR-HPV) testing. Women positive by any test (≥low-grade squamous intraepithelial lesion for Pap) were scheduled for colposcopy and biopsy. Among 248 with histological confirmation [and 174 assumed to be truly negative for cervical intraepithelial neoplasia (CIN)2+ after testing negative by all three tests], the ability of each test alone, or in combination, to detect CIN2+ was calculated to determine their utility in posttreatment follow-up. RESULTS The median age of women was 35 years, 68% were WHO stage 1-2, with a median CD4 cell count of 410 cells/μl, and 87% were on combination antiretroviral therapy. At a median of 6.3 months posttreatment, 64% had an abnormal screen by VIA, Pap, and/or HR-HPV. Among women with histological confirmation, 72 (30%) had persistent/recurrent CIN2+. As single tests, Pap correctly classified the most cases (83%) and had the highest specificity [91% (88 and 95%); sensitivity 44% (35 and 53%)], whereas HR-HPV had the highest sensitivity [85% (75 and 96%); specificity 54% (49 and 58%)]. VIA was not sensitive [27% (18 and 36%)] for the detection of posttreatment CIN2+ [specificity 82% (79 and 86%)]. CONCLUSION With the goal to minimize the number of false negatives (e.g. not miss CIN2+ posttreatment) in this population that is high-risk due to both prior cervical disease and HIV infection, HR-HPV-based algorithms are recommended.
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Determinants of Uptake of Cervical Cancer Screening Services at a No-cost Reproductive Health Clinic Managed by Nurse-Midwives. Cancer Nurs 2016; 38:177-84. [PMID: 24831038 DOI: 10.1097/ncc.0000000000000156] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of cervical cancer (CC) has been rising in sub-Saharan Africa, and health authorities in this region have responded by increasing the availability of cheap or no-cost CC screening services (CCSS), public health education, and others. However, the efforts have not yet resulted into the expected uptake of CCSS. OBJECTIVE The aim of this study was to examine the determinants of uptake of CCSS at a no-cost reproductive health clinic managed by nurse-midwives. METHODS A descriptive design and a structured interview questionnaire were used to collect data from 236 women attending the reproductive health clinic. Logistic regression statistics were used to examine the determinants of uptake of CCSS. RESULTS The mean age of participants was 28.7 years, and only 29% had received CC screening. The significant determinants of uptake of CCSS were concern about the gender of the healthcare professional (HCP) (odds ratio [OR], 5.03; P = .001), age older than 25 years (OR, 3.09; P = .005), contraceptive use (OR, 0.28; P = .02), encouragement by HCPs (OR, 0.16; P = .00), and perceived quality of CCSS (OR, 0.08; P = .00). CONCLUSIONS Gender of the HCP and encouragement or reminders by the HCP influence uptake of CCSS. Because nurse-midwives have successfully led strategies to promote other integrated reproductive health services, they can also play a key role in enhancing uptake of CCSS in resource-poor settings. IMPLICATIONS FOR PRACTICE Interventions to enhance service quality and deliberate policies requiring HCP to recommend encourage and remind clients may help to enhance uptake of CCSS in resource-poor settings.
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Current Technologies and Recent Developments for Screening of HPV-Associated Cervical and Oropharyngeal Cancers. Cancers (Basel) 2016; 8:cancers8090085. [PMID: 27618102 PMCID: PMC5040987 DOI: 10.3390/cancers8090085] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/23/2016] [Accepted: 08/30/2016] [Indexed: 12/27/2022] Open
Abstract
Mucosal infection by the human papillomavirus (HPV) is responsible for a growing number of malignancies, predominantly represented by cervical cancer and oropharyngeal squamous cell carcinoma. Because of the prevalence of the virus, persistence of infection, and long latency period, novel and low-cost methods are needed for effective population level screening and monitoring. We review established methods for screening of cervical and oral cancer as well as commercially-available techniques for detection of HPV DNA. We then describe the ongoing development of microfluidic nucleic acid-based biosensors to evaluate circulating host microRNAs that are produced in response to an oncogenic HPV infection. The goal is to develop an ideal screening platform that is low-cost, portable, and easy to use, with appropriate signal stability, sensitivity and specificity. Advances in technologies for sample lysis, pre-treatment and concentration, and multiplexed nucleic acid detection are provided. Continued development of these devices provides opportunities for cancer screening in low resource settings, for point-of-care diagnostics and self-screening, and for monitoring response to vaccination or surgical treatment.
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Msyamboza KP, Phiri T, Sichali W, Kwenda W, Kachale F. Cervical cancer screening uptake and challenges in Malawi from 2011 to 2015: retrospective cohort study. BMC Public Health 2016; 16:806. [PMID: 27535359 PMCID: PMC4989288 DOI: 10.1186/s12889-016-3530-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Malawi has the highest cervical cancer incidence and mortality in the world with age-standardized rate (ASR) of 75.9 and 49.8 per 100,000 population respectively. In response, Ministry of Health established a cervical cancer screening programme using visual inspection with acetic acid (VIA) and treatment of precancerous lesions with cryotherapy. This paper highlights the roll out, integration with family planning services and HIV ART Programme, uptake and challenges of VIA and Cryotherapy programme. METHODS We analyzed program data, supportive supervision, quarterly and annual reports from the National Cervical Cancer Control Program. We evaluated the uptake and challenges of screening services by age, HIV serostatus and trends over a five year period (2011-2015). RESULTS Between 2011 and 2015, number of cervical cancer screening sites, number of women screened and coverage per annum increased from 75 to 130, 15,331 to 49,301 and 9.3 % to 26.5 % respectively. In this five year period, a total of 145,015 women were screened. Of these, 7,349 (5.1 %) and 6,289 (4.3 %) were VIA positive and suspect cancer respectively. Overall 13,638 (9.4 %) were detected to be VIA positive or had suspect cancer. Of the 48,588 women with known age screened in 2015; 13,642 (28.1 %), 27,275 (56.1 %) and 7,671 (15.8 %) were aged 29 or less, 30-45, 46 years or more. Among 39,101 women with data on HIV serostatus; 21,546 (55.1 %) were HIV negative, 6,209 (15.9 %) were HIV positive and 11, 346 (29.0 %) status was unknown. VIA positivity rate and prevalence of suspect cancer were significantly higher in HIV positive than HIV negative women (8.8 % vs 5.0 %, 6.4 % vs 3.0 %); in women aged 30-45 years than women aged 29 years or less (5.6 % vs 2.3 %, 2.6 % vs 1.2 %) respectively, all p <0.05). The main challenge of the programme was failure to treat VIA positive women eligible for cryotherapy. Over the five year period, the programme only treated 1,001 (43.3 %) out of 2,311 eligible women and only 266 (31.8 %) of the 836 women with large lesion or suspect cancer who were referred, received the health care at the referral centre. The reasons for failure to provide cryotherapy treatment were stock out of gas, faulty/broken cryotherapy machine (usually connectors or probes) or no cryotherapy machine at all in the whole district. For women with large lesion or suspect cancer; lack of loop electrosurgical excision procedure (LEEP) machine or inadequate gynaecologists at the referral centre, were the major reasons. Cancer radiotherapy services were not available in Malawi. CONCLUSIONS This study provided data on VIA positivity rate, prevalence of suspect cancer, failure rate of cryotherapy and challenges in the provision of cryotherapy and LEEP treatment in Malawi. These data could be used as baseline for monitoring and evaluation of Human Papillomavirus (HPV) vaccination programme which the country introduced in 2013, the linkage of cervical cancer screening and women on HIV ART and the long term effect of ART, voluntary male medical circumcision on the prevalence and incidence of cervical cancer.
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Affiliation(s)
- Kelias Phiri Msyamboza
- World Health Organization, Malawi Country Office, Lilongwe, Malawi
- WHO Malawi, ADL House, City Centre, P.O. Box 30390, Lilongwe, Malawi
| | - Twambilire Phiri
- Ministry of Health, Reproductive Health Directorate, Lilongwe, Malawi
| | - Wesley Sichali
- Ministry of Health, Mzimba North District Hospital Office, Mzuzu, Malawi
| | - Willy Kwenda
- Ministry of Health, Balaka District Hospital Office, Balaka, Malawi
| | - Fanny Kachale
- Ministry of Health, Reproductive Health Directorate, Lilongwe, Malawi
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Orang’o EO, Wachira J, Asirwa FC, Busakhala N, Naanyu V, Kisuya J, Otieno G, Keter A, Mwangi A, Inui T. Factors Associated with Uptake of Visual Inspection with Acetic Acid (VIA) for Cervical Cancer Screening in Western Kenya. PLoS One 2016; 11:e0157217. [PMID: 27310005 PMCID: PMC4911084 DOI: 10.1371/journal.pone.0157217] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/26/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Cervical cancer screening has been successful in reducing the rates of cervical cancer in developed countries, but this disease remains the leading cause of cancer deaths among women in sub-Saharan Africa. We sought to understand factors associated with limited uptake of screening services in our cervical cancer-screening program in Western Kenya. PARTICIPANTS AND METHODS Using items from a previously validated cancer awareness questionnaire repurposed for use in cervical cancer and culturally adapted for use in Kenya, we interviewed 2,505 women aged 18-55 years receiving care in gynecology clinics or seeking other services in 4 health facilities in Western Kenya between April 2014 and September 2014. We used logistic regression modeling to assess factors associated with uptake (or non-uptake), associated odds ratios (ORs) and the 95% confidence intervals (95% CI). RESULTS Only two hundred and seventy-three women out of 2505 (11%) accepted VIA cervical cancer screening. Knowledge of just how women are screened for cervical cancer was significantly associated with reduced uptake of cervical cancer screening (OR: 0.53; CI 0.38-0.73) as was fear that screening would reveal a cancer (OR 0.70; CI 0.63-0.77), and reliance on prayer with the onset of illness (OR 0.43; CI 0.26-0.71). Participants who thought that one should get cervical cancer screening even if there were no symptoms were more than twice as likely to accept cervical cancer screening (OR 2.21; 95% CI 1.24-3.93). Older patients, patients living with HIV and women who do not know if bleeding immediately after sex might be a sign of cervical cancer were also more likely to accept screening (OR 1.03, CI 1.02-1.04; OR 1.78, CI 1.01-3.14; OR 2.39, CI 1.31-4.39, respectively). CONCLUSIONS In our population, a high percent of women knew that it is appropriate for all women to get cervical cancer screening, but only a small proportion of women actually got screening. There may be an opportunity to design educational materials for this population that will not only encourage participation in cervical cancer screening but also remediate misconceptions. The discussion illustrates how our findings could be used in such an effort.
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Affiliation(s)
- Elkanah Omenge Orang’o
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Reproductive Health, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Fredrick Chite Asirwa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, United States of America
- Regenstrief Institute, Inc. Indianapolis, United States of America
| | - Naftali Busakhala
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Pharmacology/Oncology, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Violet Naanyu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Job Kisuya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Grieven Otieno
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Alfred Keter
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ann Mwangi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Thomas Inui
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, United States of America
- Regenstrief Institute, Inc. Indianapolis, United States of America
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DeGregorio GA, Bradford LS, Manga S, Tih PM, Wamai R, Ogembo R, Sando Z, Liu Y, Schwaiger C, Rao SR, Kalmakis K, Kennedy Sheldon L, Nulah K, Welty E, Welty T, Ogembo JG. Prevalence, Predictors, and Same Day Treatment of Positive VIA Enhanced by Digital Cervicography and Histopathology Results in a Cervical Cancer Prevention Program in Cameroon. PLoS One 2016; 11:e0157319. [PMID: 27280882 PMCID: PMC4900564 DOI: 10.1371/journal.pone.0157319] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 05/29/2016] [Indexed: 11/25/2022] Open
Abstract
Background In 2007, the Cameroon Baptist Convention Health Services (CBCHS) implemented a screen-and-treat cervical cancer prevention program using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC). Methods We retrospectively analyzed 46,048 medical records of women who received care through the CBCHS Women’s Health Program from 2007 through 2014 to determine the prevalence and predictors of positive VIA-DC, rates of same day treatment, and cohort prevalence of invasive cervical cancer (ICC). Results Of the 44,979 women who were screened for cervical cancer, 9.0% were VIA-DC-positive, 66.8% were VIA-DC-negative, 22.0% were VIA-DC-inadequate (normal ectocervix, but portions of the transformation zone were obscured), and 2.2% were VIA-DC-uncertain (cervical abnormalities confounding VIA-DC interpretation). Risk factors significantly associated with VIA-DC-positive screen were HIV-positivity, young age at sexual debut, higher lifetime number of sexual partners, low education status and higher gravidity. In 2014, 31.1% of women eligible for cryotherapy underwent same day treatment. Among the 32,788 women screened from 2007 through 2013, 201 cases of ICC were identified corresponding to a cohort prevalence of 613 per 100,000. Conclusions High rate of VIA-DC-positive screens suggests a significant burden of potential cervical cancer cases and highlights the need for expansion of cervical cancer screening and prevention throughout the 10 regions of Cameroon. VIA-DC-inadequate rates were also high, especially in older women, and additional screening methods are needed to confirm whether these results are truly negative. In comparison to similar screening programs in sub-Saharan Africa there was low utilization of same day cryotherapy treatment. Further studies are required to characterize possible program specific barriers to treatment, for example cultural demands, health system challenges and cost of procedure. The prevalence of ICC among women who presented for screening was high and requires further investigation.
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Affiliation(s)
- Geneva A. DeGregorio
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Leslie S. Bradford
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Simon Manga
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Pius M. Tih
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Richard Wamai
- Department of African American Studies, Northeastern University, Boston, MA, United States of America
| | - Rebecca Ogembo
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Zacharie Sando
- Yaoundé Gyneco-Obstetrics and Pediatric Hospital, Yaoundé, Centre Region, Cameroon
| | - Yuxin Liu
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Constance Schwaiger
- School of Nursing, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Sowmya R. Rao
- Department of Surgery, Boston University School of Medicine, Boston, MA, United States of America
| | - Karen Kalmakis
- School of Nursing, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Lisa Kennedy Sheldon
- Department of Nursing, University of Massachusetts Boston, Boston, MA, United States of America
| | - Kathleen Nulah
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Edith Welty
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Thomas Welty
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Javier Gordon Ogembo
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
- * E-mail:
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Naud PSV, Muwonge R, Passos EP, Magno V, Matos J, Sankaranarayanan R. Efficacy, safety, and acceptability of thermocoagulation for treatment of cervical intraepithelial neoplasia in a hospital setting in Brazil. Int J Gynaecol Obstet 2016; 133:351-4. [PMID: 27005927 DOI: 10.1016/j.ijgo.2015.09.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/24/2015] [Accepted: 02/15/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the acceptability, safety, and effectiveness of thermocoagulation for the treatment of histologically proven cervical intraepithelial neoplasia grade 2-3 (CIN2-3) lesions. METHODS In a retrospective study, data were obtained for women treated for CIN2-3 lesions by thermocoagulation at the Hospital de Clínicas de Porto Alegre, Brazil, between March 6, 2012, and October 29, 2013, and followed up after 1 year. The proportions of women with no evidence of disease, adverse effects, or complications were determined. RESULTS Among 52 women included, 44 (85%) had no evidence of disease 1year after thermocoagulation. The rate of no disease at follow-up was similar for women treated for CIN2 (17/20 [85%]) and CIN3 (27/32 [84%]). No serious adverse effects or complications requiring hospitalization were observed during the follow-up period. CONCLUSION Thermocoagulation is useful in the management of ectocervical CIN and should be integrated into public health services for management of cervical cancer.
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Affiliation(s)
- Paulo S V Naud
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Richard Muwonge
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Eduardo P Passos
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Valentino Magno
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jean Matos
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Rengaswamy Sankaranarayanan
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
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Shiferaw N, Salvador-Davila G, Kassahun K, Brooks MI, Weldegebreal T, Tilahun Y, Zerihun H, Nigatu T, Lulu K, Ahmed I, Blumenthal PD, Asnake M. The Single-Visit Approach as a Cervical Cancer Prevention Strategy Among Women With HIV in Ethiopia: Successes and Lessons Learned. GLOBAL HEALTH: SCIENCE AND PRACTICE 2016; 4:87-98. [PMID: 27016546 PMCID: PMC4807751 DOI: 10.9745/ghsp-d-15-00325] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/20/2016] [Indexed: 01/02/2023]
Abstract
With the single-visit approach for cervical cancer prevention, women with positive “visual inspection of the cervix with acetic acid wash” (VIA) test results receive immediate treatment of the precancerous lesion with cryotherapy. The approach worked successfully for women with HIV in Ethiopia in secondary and tertiary health facilities, with high screening and cryotherapy treatment rates. Sustainability and appropriate scale-up of such programs must address wider health system challenges including human resource constraints and shortage of essential supplies. Introduction: Cervical cancer is the second most common form of cancer for women in Ethiopia. Using a single-visit approach to prevent cervical cancer, the Addis Tesfa (New Hope) project in Ethiopia tested women with HIV through visual inspection of the cervix with acetic acid wash (VIA) and, if tests results were positive, offered immediate cryotherapy of the precancerous lesion or referral for loop electrosurgical excision procedure (LEEP). The objective of this article is to review screening and treatment outcomes over nearly 4 years of project implementation and to identify lessons learned to improve cervical cancer prevention programs in Ethiopia and other resource-constrained settings. Methods: We analyzed aggregate client data from August 2010 to March 2014 to obtain the number of women with HIV who were counseled, screened, and treated, as well as the number of annual follow-up visits made, from the 14 tertiary- and secondary-level health facilities implementing the single-visit approach. A health facility assessment (HFA) was also implemented from August to December 2013 to examine the effects of the single-visit approach on client flow, staff workload, and facility infrastructure 3 years after initiating the approach. Results: Almost all (99%) of the 16,632 women with HIV counseled about the single-visit approach were screened with VIA during the study period; 1,656 (10%) of them tested VIA positive (VIA+) for precancerous lesions. Among those who tested VIA+ and were thus eligible for cryotherapy, 1,481 (97%) received cryotherapy treatment, but only 80 (63%) women eligible for LEEP actually received the treatment. The HFA results showed frequent staff turnover, some shortage of essential supplies, and rooms that were judged by providers to be too small for delivery of cervical cancer prevention services. Conclusion: The high proportions of VIA screening and cryotherapy treatment in the Addis Tesfa project suggest high acceptance of such services by women with HIV and feasibility of implementation in secondary- and tertiary-level health facilities. However, success of cervical cancer prevention programming must address wider health system challenges to ensure sustainability and appropriate scale-up to the general population of Ethiopia and other resource-constrained settings.
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Affiliation(s)
| | | | | | - Mohamad I Brooks
- Pathfinder International, Watertown, MA, and Boston University School of Public Health, Boston, MA, USA
| | | | | | | | | | - Kidest Lulu
- Pathfinder International, Addis Ababa, Ethiopia
| | - Ismael Ahmed
- Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Paul D Blumenthal
- Stanford Program for International Reproductive Education and Services (SPIRES), Stanford University School of Medicine, Stanford, CA, USA
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Subramanian S, Sankaranarayanan R, Esmy PO, Thulaseedharan JV, Swaminathan R, Thomas S. Clinical trial to implementation: Cost and effectiveness considerations for scaling up cervical cancer screening in low- and middle-income countries. J Cancer Policy 2016. [DOI: 10.1016/j.jcpo.2015.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Grover S, Raesima M, Bvochora-Nsingo M, Chiyapo SP, Balang D, Tapela N, Balogun O, Kayembe MKA, Russell AH, Monare B, Tanyala S, Bhat J, Thipe K, Nchunga M, Mayisela S, Kizito B, Ho-Foster A, Gaolebale BE, Gaolebale PA, Efstathiou JA, Dryden-Peterson S, Zetola N, Hahn SM, Robertson ES, Lin LL, Morroni C, Ramogola-Masire D. Cervical Cancer in Botswana: Current State and Future Steps for Screening and Treatment Programs. Front Oncol 2015; 5:239. [PMID: 26579491 PMCID: PMC4630577 DOI: 10.3389/fonc.2015.00239] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/09/2015] [Indexed: 12/03/2022] Open
Abstract
Botswana has a high burden of cervical cancer due to a limited screening program and high HIV prevalence. About 60% of the cervical cancer patients are HIV positive; most present with advanced cervical disease. Through initiatives by the Botswana Ministry of Health and various strategic partnerships, strides have been made in treatment of pre-invasive and invasive cancer. The See and Treat program for cervical cancer is expanding throughout the country. Starting in 2015, school-going girls will be vaccinated against HPV. In regards to treatment of invasive cancer, a multidisciplinary clinic has been initiated at the main oncology hospital to streamline care. However, challenges remain such as delays in treatment, lack of trained human personnel, limited follow-up care, and little patient education. Despite improvements in the care of pre-invasive and invasive cervical cancer patients, for declines in cervical cancer-related morbidity and mortality to be achieved, Botswana needs to continue to invest in decreasing the burden of disease and improving patient outcomes of patients with cervical cancer.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA ; Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Mmakgomo Raesima
- National Cervical Cancer Prevention Programme, Ministry of Health , Gaborone , Botswana
| | | | | | - Dawn Balang
- Department of Oncology, Gaborone Private Hospital , Gaborone , Botswana
| | - Neo Tapela
- Princess Marina Hospital , Gaborone , Botswana ; Division of Global Health Equity, Brigham and Women's Hospital , Boston, MA , USA
| | - Onyinye Balogun
- Department of Radiation Oncology, New York University Perlmutter Cancer Center , New York, NY , USA
| | | | - Anthony H Russell
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Barati Monare
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Senate Tanyala
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Jailakshmi Bhat
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Kealeboga Thipe
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Metlha Nchunga
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Susan Mayisela
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Balladiah Kizito
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Ari Ho-Foster
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana ; Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | | | | | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | | | - Nicola Zetola
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Stephen M Hahn
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Erle S Robertson
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Lilie L Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Chelsea Morroni
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana ; Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA ; School of Medicine, University of Botswana , Gaborone , Botswana ; Institute for Women's Health, University College London , London , UK ; Institute for Global Health, University College London , London , UK
| | - Doreen Ramogola-Masire
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana ; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA ; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana , Gaborone , Botswana
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Thulaseedharan JV, Malila N, Swaminathan R, Esmy PO, Cherian M, Hakama M, Muwonge R, Sankaranarayanan R. Effect of Screening on Variation in Cervical Cancer Survival by Socioeconomic Determinants--a Study from Rural South India. Asian Pac J Cancer Prev 2015. [PMID: 26225659 DOI: 10.7314/apjcp.2015.16.13.5237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Socioeconomic factors are associated with screening in terms of reducing the risk of cervical cancer. This study aimed to clearly establish the effect of screening on variation in socio-economic factor-specific survival estimates. MATERIALS AND METHODS Survival estimates were calculated using the life table method for 165 women from the routine care control arm and 67 from the visual inspection with acetic acid screening arm diagnosed with cervical cancer during 2000-2006 in rural south India. Kaplan-Meier survival curves were plotted to compare the variation in survival by socioeconomic factors. RESULTS Whereas there was a significant variation in survival estimates of the different categories of age at diagnosis among the screen-detected cancers with women aged<50 years having an improved survival, no significant variation was noted among women diagnosed with cervical cancer from the control arm. Compared to the variation among the cancer cases detected in the unscreened control group, screening widened the variation in survival estimates by age and type of house, and reduced the variation by education. The direction of the magnitude of the survival estimates was reversed within the different categories of occupation, marital status and household income in the screen-detected cancer cases compared to control group cancer cases. Also, women diagnosed with stage 1 disease had a very good survival. CONCLUSIONS Screening changed the pattern of survival by socio-economic factors. We found improved survival rates in screened women aged <50 years, with no formal education, manual workers and married women.
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Affiliation(s)
- Jissa Vinoda Thulaseedharan
- Achutha Menon Centre for Health Science Studies (AMCHSS), Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Chennai, India E-mail :
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Kress CM, Sharling L, Owen-Smith AA, Desalegn D, Blumberg HM, Goedken J. Knowledge, attitudes, and practices regarding cervical cancer and screening among Ethiopian health care workers. Int J Womens Health 2015; 7:765-72. [PMID: 26261427 PMCID: PMC4527576 DOI: 10.2147/ijwh.s85138] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Though cervical cancer incidence has dramatically decreased in resource rich regions due to the implementation of universal screening programs, it remains one of the most common cancers affecting women worldwide and has one of the highest mortality rates. The vast majority of cervical cancer-related deaths are among women that have never been screened. Prior to implementation of a screening program in Addis Ababa University-affiliated hospitals in Ethiopia, a survey was conducted to assess knowledge of cervical cancer etiology, risk factors, and screening, as well as attitudes and practices regarding cervical cancer screening among women's health care providers. METHODS Between February and March 2012 an anonymous, self-administered survey to assess knowledge, attitudes, and practices related to cervical cancer and its prevention was distributed to 334 health care providers at three government hospitals in Addis Ababa, Ethiopia and three Family Guidance Association clinics in Awassa, Adama, and Bahir Dar. Data were analyzed using SPSS software and chi-square test was used to test differences in knowledge, attitudes, and practices across provider type. RESULTS Overall knowledge surrounding cervical cancer was high, although awareness of etiology and risk factors was low among nurses and midwives. Providers had no experience performing cervical cancer screening on a routine basis with <40% having performed any type of cervical cancer screening. Reported barriers to performing screening were lack of training (52%) and resources (53%); however the majority (97%) of providers indicated cervical cancer screening is an essential part of women's health care. CONCLUSION There is a clear need among women's health care providers for education regarding cervical cancer etiology, risk factors and for training in low-tech, low-cost screening methods. Meeting these needs and improving the infrastructure necessary to implement appropriate screening programs is essential to reduce the burden of cervical cancer in Ethiopia.
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Affiliation(s)
- Catherine M Kress
- Department of Gynecology and Obstetrics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lisa Sharling
- Division of Infectious Diseases, Department of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ashli A Owen-Smith
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dawit Desalegn
- Department of Gynecology and Obstetrics, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Henry M Blumberg
- Division of Infectious Diseases, Department of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer Goedken
- Department of Gynecology and Obstetrics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Poli UR, Bidinger PD, Gowrishankar S. Visual Inspection with Acetic Acid (VIA) Screening Program: 7 Years Experience in Early Detection of Cervical Cancer and Pre-Cancers in Rural South India. Indian J Community Med 2015; 40:203-7. [PMID: 26170547 PMCID: PMC4478664 DOI: 10.4103/0970-0218.158873] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 11/05/2014] [Indexed: 12/27/2022] Open
Abstract
Cervical cancer continues to be a major public health problem in India in the absence of wide spread organised cervical screening programs. Visual inspection of the cervix with acetic acid (VIA) is an effective, inexpensive screening test that can be combined with simple treatment procedures for early cervical lesions, provided by trained health workers. We report 7 years experience in early detection of cervical cancer and pre-cancers using the VIA test in a community-based program in rural Andhra Pradesh, India where there are no existing organised cervical screening programs.
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Affiliation(s)
- Usha Rani Poli
- Associate Professor of Gynaecological Oncology, Department of Gynaecological Oncology, Mehdi Nawaz Jung Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - P D Bidinger
- Director, Institute for Rural Health Studies, Hyderabad, Telangana, India
| | - Swarnalata Gowrishankar
- Chief Pathologist, Department of Pathology, Apollo Hospital, Jubilee Hills, Hyderabad, Telangana, India
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Ndoua CCN, Tebeu PM, Kemfang JD, Kasia JM. [Evaluation of results after treatment of cervical intraepithelial lesions by cryotherapy: a preliminary study at the University Hospital Centre in Yaounde: report of 21 cases]. Pan Afr Med J 2015; 20:225. [PMID: 26140068 PMCID: PMC4482521 DOI: 10.11604/pamj.2015.20.225.4618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 01/08/2015] [Indexed: 11/11/2022] Open
Abstract
Nous rapportons les résultats d'une série de 21 cas de prise en charge par cryothérapie de lésions intra-épithéliales cervicales au Centre Hospitalier et Universitaire (CHU) de Yaoundé. Notre objectif principal était d’évaluer les résultats préliminaires de la prise en charge des lésions précancéreuses éligibles pour la cryothérapie. Il s'agissait d'une étude transversale descriptive qui s'est étalée sur 24 mois. Etaient inclus dans l’étude toutes les femmes traitées par cryothérapie. Nous avons exclu les patientes traitées par une autre méthode, les patientes perdues de vue et les dossiers incomplets. Le statut cervical a été déterminé à 6 semaines, 6 mois et 12 mois. Les complications précoces et tardives ont également été répertoriées. Au total 95.2% des lésions étaient cicatrisées à 6 semaines. A 6 mois, toutes les lésions avaient disparu et au 12ème mois, la guérison était effective chez 95.2% des patientes. Les saignements et l'hydrorrhée étaient les principales complications tardives avec des fréquences respectives de 66.7% et 95.2%. Aucun cas de sténose cervicale n'a été répertorié. La cryothérapie peut être utilisée comme méthode de traitement pour des lésions précancéreuses du col.
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Affiliation(s)
- Claude Cyrille Noa Ndoua
- Faculté de Médecine et Sciences Biomédicales de l'Université de Yaoundé I, Cameroun ; Centre Hospitalier de Recherche et d'Application de la Chirurgie Endoscopique et de la Reproduction Humaine, Cameroun
| | - Pierre Marie Tebeu
- Faculté de Médecine et Sciences Biomédicales de l'Université de Yaoundé I, Cameroun ; Centre Hospitalier et Universitaire de Yaoundé, Cameroun
| | - Jean Dupont Kemfang
- Faculté de Médecine et Sciences Biomédicales de l'Université de Yaoundé I, Cameroun ; Hôpital Général de Yaoundé, Cameroun
| | - Jean Marie Kasia
- Faculté de Médecine et Sciences Biomédicales de l'Université de Yaoundé I, Cameroun ; Centre Hospitalier de Recherche et d'Application de la Chirurgie Endoscopique et de la Reproduction Humaine, Cameroun ; Hôpital Général de Yaoundé, Cameroun
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Thulaseedharan JV, Malila N, Esmy PO, Muwonge R, Hakama M, Sankaranarayanan R. Risk of invasive cancer among women visually screened and colposcopy triaged by trained nurses in rural South India. Int J Gynaecol Obstet 2015; 129:104-8. [PMID: 25661324 DOI: 10.1016/j.ijgo.2014.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/11/2014] [Accepted: 01/22/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To estimate the long-term risk of cervical cancer among women screened by visual inspection with acetic acid (VIA) and to evaluate the benefit of additional colposcopy triage in rural south India. METHODS A retrospective analysis was conducted among 31 343 women who had undergone VIA at Dindigul district, India between January 1, 2000, and August 5, 2003, as part of a randomized screening trial. Women with positive VIA test results were offered colposcopy triage by trained nurses. Cervical cancer incidence data during follow-up (January 1, 2000, to December 31, 2012) were obtained from a regional cancer registry. RESULTS Among 3021 screen-positive women free of cancer at baseline, 2974 women underwent colposcopy; colposcopic abnormalities suggestive of precancerous lesions were detected among 2792 of these women (93.9%). Compared with the women with negative VIA screening results, the hazard ratio (HR) of cervical cancer during follow-up among the VIA-positive women without colposcopic abnormalities was 6.5 (95% confidence interval [CI], 1.6-27.1). The risk was similar among VIA-positive women with colposcopic abnormalities but without histological confirmation (HR5.2; 95% CI, 1.9-14.6). CONCLUSION The high risk of cancer among women without colposcopic abnormalities who tested positive by VIA suggested that screening without triage is potentially effective.
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Affiliation(s)
- Jissa V Thulaseedharan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India; School of Health Sciences, University of Tampere, Tampereen Yliopisto, Finland
| | - Nea Malila
- School of Health Sciences, University of Tampere, Tampereen Yliopisto, Finland; Finnish Cancer Registry, Pieni Roobertinkatu, Helsinki, Finland
| | - Pulikottil O Esmy
- Christian Fellowship Community Health Centre, Ambilikkai, Tamil Nadu, India
| | - Richard Muwonge
- Screening Group, International Agency for Research on Cancer, Lyon, France.
| | - Matti Hakama
- School of Health Sciences, University of Tampere, Tampereen Yliopisto, Finland; Finnish Cancer Registry, Pieni Roobertinkatu, Helsinki, Finland
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Martin CE, Tergas AI, Wysong M, Reinsel M, Estep D, Varallo J. Evaluation of a single-visit approach to cervical cancer screening and treatment in Guyana: feasibility, effectiveness and lessons learned. J Obstet Gynaecol Res 2015; 40:1707-16. [PMID: 24888938 DOI: 10.1111/jog.12366] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 12/02/2013] [Indexed: 11/29/2022]
Abstract
AIM To evaluate a cervical cancer prevention project in Guyana utilizing visual inspection with acetic acid (VIA) and immediate cryotherapy in a single-visit approach; and to identify lessons learned to inform the improvement of cervical cancer prevention programs in Guyana and other low-resource settings. METHODS Service records from January 2009 to June 2012 were analyzed for 18 cervical cancer prevention sites across Guyana. Records included women's HIV status, data on visual inspection with acetic acid screening and treatment status for women's initial and 1-year follow-up screenings, provider training and retention. A process evaluation was conducted in 2011 to identify programmatic strengths and interventions for integration, scale-up and sustainability. RESULTS During the 42-month interval, 21,597 new screenings were performed, reaching 95% of HIV(+) women enrolled in care and 17% of women aged 25-49 years in Guyana. The VIA(+) rate was 13% (n = 2806); 85% of women eligible for cryotherapy received immediate treatment. Half of VIA(+) women treated with cryotherapy or loop electrosurgical excision procedure returned for a 1-year follow-up screening (n = 1027); 95% were VIA(-) at the second screening. Non-physician providers were more likely to continue offering services than physicians. Most programmatic challenges were related to systemic rather than technical/clinical issues. CONCLUSION The single-visit approach-based program is feasible, effective, and when scaled up, likely to have an impact on overall incidence of cervical cancer. Services can be shifted to non-physicians for scale-up of high-quality cervical cancer prevention services nationally. To ensure sustainability and expansion, support structures should be prioritized.
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Affiliation(s)
- Caitlin E Martin
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Sankaranarayanan R, Qiao YL, Keita N. The next steps in cervical screening. WOMEN'S HEALTH (LONDON, ENGLAND) 2015; 11:201-12. [PMID: 25776294 DOI: 10.2217/whe.14.70] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Cervical cancer is fourth most common cancer among women with four-fifths of the global burden in low- and middle-income countries (LMICs). Persistent infection with one of the high-risk types of human papillomaviruses (HPV), particularly HPV 16/18, is the central cause of cervical neoplasia. Progress in developing feasible, alternative screening methods in LMICs and HPV vaccines have further improved cervical cancer prevention prospects. While existing screening programs in high-income countries should be re-organized, in view of the downstream effects of national HPV vaccination programs, LMICs should introduce national programs to vaccinate single year cohorts of girls aged 9-13 years with two or three doses and screen 30-35-year-old women with HPV testing to pragmatically decrease their high disease burden.
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Fong J, Gyaneshwar R, Lin S, Morrell S, Taylor R, Brassil A, Stuart A, McGowan C. Cervical Screening Using Visual Inspection with Acetic Acid (VIA) and Treatment with Cryotherapy in Fiji. Asian Pac J Cancer Prev 2015; 15:10757-62. [DOI: 10.7314/apjcp.2014.15.24.10757] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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