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Abstract
BackgroundCervical cancer is the fourth most common cancer worldwide among women, with the number of new cases increasing from 493 243 in 2002 to 527 000 in 2012. These numbers are likely to be underestimated because given the lack of registration resources, cervical cancer deaths are usually under-reported in low-income countries.AimTo describe the distribution of and trends in visual inspection with acetic acid (VIA) to detected cervical abnormalities in Swaziland by reviewing records of VIA examinations performed at two main hospitals in Swaziland between 2011 and 2014.SettingMbabane Government Hospital and Realign Fitkin Memorial (RFM).MethodsRecords of cervical screening using VIA at the Mbabane government hospital and RFM hospital between 2011 and 2014 were retrieved. Positivity rates (PRs) of VIA with 95% confidence intervals (95% CI) were calculated and used as proxies of cervical abnormalities. Odds ratios of the association between VIA-detected cervical abnormalities and human immunodeficiency virus (HIV) status were estimated using logistic regressions.ResultsVIA was positive in 1828 of 12 151 VIA records used for analysis (15%, 95% CI: 14.4–15.7). VIA was positive in 9% (36 of 403) women under the age of 20, in 15.5% (1714 of 11 046) of women aged 20–49 years and in 11.1% (78 of 624) of women aged 50–64 years. A decreasing trend of VIA positivity was observed over time at both screening centres (p for trend < 0.001). Of 2697 records with Papanicolaou results, 20% (67 of 331) VIA-positives and only 5% (114 of 2366) VIA negatives had high-grade squamous intraepithelial lesion. Among 4578 women with reported HIV status, 1702 were HIV-positive (37.2%, 95% CI: 35.8–38.6). The prevalence of HIV in VIA-positive women was 62.5% (95% CI: 58.7–66.2), almost double that among VIA-negative women (33.0%, 95% CI: 31.6–34.5) and that among all women screened (p < 0.001). HIV-positive women were 3.4 times more likely to have cervical abnormalities on VIA than HIV-negative women (OR: 3.4, 95% CI: 2.8–4.0, p < 0.01).ConclusionThe high VIA PRs observed over four years in this study may reflect the prevalence of cervical abnormalities, in particular, in HIV-positive women. VIA is not a robust screening test, but it can play a major role in strengthening and expanding cervical cancer screening prevention programmes in resource-limited countries.
Highlights
Cervical cancer is the fourth most common cancer worldwide among women, with the number of new cases increasing from 493 243 in 2002 to 527 000 in 2012, and the number of deaths slowly decreasing from 274 000 in 2002 to 265 000 in 2008.1,2 These numbers are likely to be underestimated because given the lack of registration resources, cervical cancer deaths are usually under-reported in low-income countries
Over 90% of all cervical cancer cases are caused by persistent infection with high-risk human papillomaviruses,[3,4] which can lead to pre-cancerous lesions and invasive cervical carcinoma (ICC) if not treated
Co-infection with human immunodeficiency virus (HIV) in the sub-Saharan African countries increases the burden of cervical abnormalities because high-risk human papillomaviruses (hr-human papillomavirus (HPV)) infections are more prevalent and http://www.phcfm.org
Summary
Cervical cancer is the fourth most common cancer worldwide among women, with the number of new cases increasing from 493 243 in 2002 to 527 000 in 2012, and the number of deaths slowly decreasing from 274 000 in 2002 to 265 000 in 2008.1,2 These numbers are likely to be underestimated because given the lack of registration resources, cervical cancer deaths are usually under-reported in low-income countries. Cervical cancer is the fourth most common cancer worldwide among women, with the number of new cases increasing from 493 243 in 2002 to 527 000 in 2012 These numbers are likely to be underestimated because given the lack of registration resources, cervical cancer deaths are usually under-reported in low-income countries
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