Abstract
Cervical cancer (CC) is the leading cause of cancer‐related death among women in sub‐Saharan Africa, primarily because of limited access to effective screening and preventive treatment. Our aim was to assess the feasibility of a human papillomavirus (HPV)‐based CC screen‐and‐treat approach in a low‐resource context. We recruited 1012 women aged 30–49 years through a CC screening campaign conducted in the District Hospital of Dschang, Cameroon. Participants performed HPV self‐sampling, which was tested for high‐risk HPV (HR‐HPV) DNA using the point‐of‐care Xpert HPV assay. All HPV‐positive women were invited for visual inspection with acetic acid and Lugol's iodine (VIA/VILI) to exclude CC or enable triage. A cervical sample for histological analysis was also collected. Women positive for HPV 16/18/45 and for other HR‐HPV with pathological VIA/VILI were selected to undergo treatment with thermocoagulation. The HPV prevalence in the study population was 18.5% (n = 187); of these cases, 20 (10.6%), 42 (22.3%) and 140 (74.9%) were positive for HPV16, HPV18/45 and other HR‐HPV types, respectively. Overall, 107/185 (57.8%) VIA/VILI examinations were classified as pathological and 78 (42.2%) as normal. Women positive for HPV16/18/45 were 4.2 times more likely to harbor cervical intraepithelial neoplasia grade 2 or worse (CIN2+) than those with other HPV types. The specificity of HPV 16/18/45 genotypes for detection of high‐grade lesions among HR‐HPV positive women was higher than that of VIA/VILI in all age groups. The sensitivity and specificity of VIA/VILI in detecting CIN2+ among HPV positive women were 80% and 44%, respectively. Overall, 110/121 screen‐positive women (90.9%) were eligible for, and were treated with, thermocoagulation. An HPV‐based screen‐and‐treat approach is feasible in a low‐resource context and may contribute to improving the effectiveness of CC prevention programs. Immediate thermocoagulation treatment for women who are HPV16‐ and/or HPV18/45‐positive is a practical approach for the treatment of CIN2+. The combination of HPV‐testing and VIA/VILI for CC screening might reduce overtreatment.
Highlights
Cervical cancer (CC) is the second most common cancer in women worldwide, and is a leading cause of cancer death in women in low-resource countries such as Cameroon, despite being largely avoidable
Cytology-based CC screening programs have successfully reduced CC incidence in high-income countries, such dramatic reduction in incidence has not been observed in low-and medium-income countries (LMIC) [1]
Recent evidence has demonstrated that the quality of self-c ollected cervicovaginal samples is similar to that of samples obtained by physicians for the detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) lesion [6]
Summary
Cervical cancer (CC) is the second most common cancer in women worldwide, and is a leading cause of cancer death in women in low-resource countries such as Cameroon, despite being largely avoidable. Cytology-based CC screening programs have successfully reduced CC incidence in high-income countries, such dramatic reduction in incidence has not been observed in low-and medium-income countries (LMIC) [1]. Recent studies have shown that HPV-b ased screening has a greater sensitivity than conventional cytology- based screening programs for the detection of precancerous lesions and CC [3, 4]. Compared with the more frequent screening visits required by cytology- based programs, the use of a highly sensitive test once or twice in a lifetime is more effective and applicable in low-resource settings [5]. Recent evidence has demonstrated that the quality of self-c ollected cervicovaginal samples is similar to that of samples obtained by physicians for the detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) lesion [6]. It offers the potential to reduce medical costs and overcome shortages of qualified staff [9]
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