Assessment of Two Mass Screening Campaigns for Pre-Cancerous and Cancerous Lesions of the Uterine Cervix using Colposcopy

Abstract

Objectives: Study the epidemiological profile of patients seen for colposcopy, specify the indications for colposcopy, describe the lesions encountered and their treatment and determine the factors associated with cervical lesions. Material and methods: This was a cross-sectional study conducted during October 2021. It concerned 2 “fairground” campaigns for systematic mass screening of pre-cancerous and cancerous lesions of the cervix at the Institute of social Hygiene in Dakar and at the Inter-Army Medical Center in Thiès. The parameters studied were the epidemiological data, the results of the colposcopic examination and histology. Data analysis was performed with Excel 2010 and Epi info 7.2. softwares. Results: During the two mass screening campaigns, we performed 50 colposcopic examinations. The epidemiological profile was a woman aged 45 on average, married (86%), multiparous (54%), in period of genital activity (54%) with a first sexual intercourse made on average at 22 years old. All the patients had benefited from a visual inspection with acetic acid and lugol. Visual inspection with acetic acid and lugol showed 15 positive VIA (30%), 14 positive VIL (28%) and 21 cases of positive VIA and VIL (42%). Colposcopy was satisfactory in most patients (78%). It found 36% atypical grade 2 transformation, 10% atypical grade 1 transformation, 2% association of atypical grade 1 and 2 transformation and 10% viral colpitis. We also recorded 18% of normal colposcopy. In our series, the majority of patients in whom the VIA and VIL tests were positive presented at colposcopy either an atypical grade 2 transformation lesion (72.2%) or a ATG 1+2 lesion (5.5%). This rate was only 14.3% in those who only had the positive IVA test and 50% in the case of positive VIL. A biopsy under colposcopy was performed in 20 patients (40%). Of these, only 5 (25%) had brought back the results. It was a CIN 2 and 4 normal results. A multivariate analysis allowed us to find that TAG 2 lesions were more frequent in patients aged 45 and over (60%) (p=0.46), primiparous (100%) (p=0.62), those who had had first sexual intercourse before the age of 20 (69.2%) (p=0.39) and who had not used a contraceptive (88.9%) (p=0.13). Conclusion: Mass screening campaigns constitute in our developing countries an opportunity to diagnose and treat pre-cancerous and cancerous lesions of the cervix. However, it will be necessary to sensitize the patients screened for a better adhesion to the follow-up.