Abstract
BackgroundCervical cancer is the commonest cancer amongst African women, and yet preventative services are often inadequate.AimThe purpose of the study was to assess the safety, acceptability and feasibility of visual inspection with acetic acid and cervicography (VIAC) followed by cryotherapy or a loop electrical excision procedure (LEEP) at a single visit for prevention of cancer of the cervix.SettingThe United Bulawayo Hospital, Zimbabwe.MethodsThe study was descriptive, using retrospective data extracted from electronic medical records of women attending the VIAC clinic. Over 24 months 4641 women visited the clinic and were screened for cervical cancer using VIAC. Cryotherapy or LEEP was offered immediately to those that screened positive. Treated women were followed up at three months and one year.ResultsThe rate of positive results on VIAC testing was 10.8%. Of those who were eligible, 17.0% received immediate cryotherapy, 44.1% received immediate LEEP, 1.9% delayed treatment, and 37.0% were referred to a gynaecologist. No major complications were recorded after cryotherapy or LEEP. Amongst those treated 99.5% expressed satisfaction with their experience. Only 3.2% of those treated at the clinic had a positive result on VIAC one year later. The service was shown to be feasible to sustain over time with the necessary consumables. There were no service-related treatment postponements and the clinic staff and facility were able to meet the demand for the service.ConclusionA single-visit approach using VIAC, followed by cryotherapy or LEEP, proved to be safe, acceptable and feasible in an urban African setting in Bulawayo, Zimbabwe. Outcomes a year later suggested that treatment had been effective.
Highlights
Cervical cancer is the commonest cancer amongst African women and globally is exceeded only by breast cancer.[1]
More than half (52.5%) of those screened tested HIV positive; some of them came to the clinic with their results whilst others were screened at the clinic on the VIA with cervicography (VIAC) day
Of those who were eligible, 17.0% received immediate cryotherapy, 44.1% immediate loop electrical excision procedure (LEEP), 1.9% delayed treatment, and 37.0% were referred to a gynaecologist
Summary
Cervical cancer is the commonest cancer amongst African women and globally is exceeded only by breast cancer.[1]. In resource-limited countries, like Zimbabwe, a shortage of skilled health workers, lack of political will and insufficient funds for women’s health activities contribute to these high rates.[3]. Treatment of advanced cancer is extremely difficult in most developing countries, whilst successful treatment of pre-invasive cancer should be technically possible.[4] Introduction of the Papanicolau smear has successfully decreased the incidence of invasive cancer and mortality in developed countries.[4] even screening is difficult to implement in developing countries because of poverty, poor infrastructure, lack of financial and human resources, and the disempowerment of women.[3]. Cervical cancer is the commonest cancer amongst African women, and yet preventative services are often inadequate
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