In:
Cancer Medicine, Wiley, Vol. 6, No. 7 ( 2017-07), p. 1752-1761
Abstract:
Cervical cancer ( CC ) is the leading cause of cancer‐related death among women in sub‐Saharan Africa, primarily because of limited access to effective screening and preventive treatment. Our aim was to assess the feasibility of a human papillomavirus ( HPV )‐based CC screen‐and‐treat approach in a low‐resource context. We recruited 1012 women aged 30–49 years through a CC screening campaign conducted in the District Hospital of Dschang, Cameroon. Participants performed HPV self‐sampling, which was tested for high‐risk HPV ( HR ‐ HPV ) DNA using the point‐of‐care Xpert HPV assay. All HPV ‐positive women were invited for visual inspection with acetic acid and Lugol's iodine ( VIA / VILI ) to exclude CC or enable triage. A cervical sample for histological analysis was also collected. Women positive for HPV 16/18/45 and for other HR ‐ HPV with pathological VIA / VILI were selected to undergo treatment with thermocoagulation. The HPV prevalence in the study population was 18.5% ( n = 187); of these cases, 20 (10.6%), 42 (22.3%) and 140 (74.9%) were positive for HPV 16, HPV 18/45 and other HR ‐ HPV types, respectively. Overall, 107/185 (57.8%) VIA / VILI examinations were classified as pathological and 78 (42.2%) as normal. Women positive for HPV 16/18/45 were 4.2 times more likely to harbor cervical intraepithelial neoplasia grade 2 or worse ( CIN 2+) than those with other HPV types. The specificity of HPV 16/18/45 genotypes for detection of high‐grade lesions among HR ‐ HPV positive women was higher than that of VIA / VILI in all age groups. The sensitivity and specificity of VIA / VILI in detecting CIN 2+ among HPV positive women were 80% and 44%, respectively. Overall, 110/121 screen‐positive women (90.9%) were eligible for, and were treated with, thermocoagulation. An HPV ‐based screen‐and‐treat approach is feasible in a low‐resource context and may contribute to improving the effectiveness of CC prevention programs. Immediate thermocoagulation treatment for women who are HPV 16‐ and/or HPV 18/45‐positive is a practical approach for the treatment of CIN 2+. The combination of HPV ‐testing and VIA / VILI for CC screening might reduce overtreatment.
Type of Medium:
Online Resource
ISSN:
2045-7634
,
2045-7634
DOI:
10.1002/cam4.2017.6.issue-7
Language:
English
Publisher:
Wiley
Publication Date:
2017
detail.hit.zdb_id:
2659751-2
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