Abstract
BackgroundIn the Democratic Republic of Congo (DRC), practical and affordable strategies for cervical cancer screening are needed to detect and treat pre-cancerous and cancerous lesions in a timely fashion. This study presents the results of mass cervical cancer screenings in eastern DRC using a “screen and treat” approach.MethodsIn two mass cervical cancer screening campaigns, patients underwent a combination of visual inspection of the cervix with acetic acid, visual inspection of the cervix with Lugol iodine solution, and colposcopy with or without loop electrosurgical excision procedure. Cervical biopsy samples were taken for histology analysis. Marital status, age, history of abnormal bleeding, and number of pregnancies were recorded for each patient and association analyses were performed.ResultsOf the 644 women who received cervical pre-cancer and cancer screening, 48 had suspicious pre-cancer and cancer lesions that were biopsied (7.45%). On histology analysis cervical intraepithelial neoplasia (CIN) was identified in 15 (2.33%), squamous cell carcinoma (SCC) was identified in 6 (0.93%) and non-neoplastic cervicitis was identified in 11 (1.71%). Abnormal bleeding was significantly associated with CIN/SCC but no significant association was observed for prior pregnancy, patients’ home region, or age.ConclusionForty-eight women with suspicious pre-cancerous or cancerous lesions were successfully identified using the “screen and treat” approach in eastern DRC, suggesting that this approach is feasible for reducing cervical cancer morbidity and mortality. However, community awareness would be necessary, providers would have to be properly trained, referral and follow up mechanisms would have to be put in place, and equipment / supplies would have to be secured if the “screen and treat” approach is to be successful on a wider scale. There is ongoing need for HPV vaccination in DRC as a primary prevention strategy against cervical cancer.
Highlights
In the Democratic Republic of Congo (DRC), practical and affordable strategies for cervical cancer screening are needed to detect and treat pre-cancerous and cancerous lesions in a timely fashion
In the first cervical cancer screening campaign (August 21–24, 2013), 233 patients were screened and in the second (August 3–7, 2015), 411 patients were screened giving a total of 644 patients
This study demonstrates that cervical cancer screening was acceptable to women who came forward and the treatment was generally well received with only minor complications
Summary
In the Democratic Republic of Congo (DRC), practical and affordable strategies for cervical cancer screening are needed to detect and treat pre-cancerous and cancerous lesions in a timely fashion. Cervical cancer is the second most common cancer among women globally, with an estimated 528,000 new cases and 266,000 deaths annually worldwide [1]. Women in low-income countries are disproportionately affected and in 2012, 85% of all new diagnoses of cervical cancer as well as 87% of all cervical cancer deaths were reported from low and middle- income countries (LMIC) [1]. Well-organized screening and treatment programs for pre-cancerous and cancerous lesions as well as introduction of the human papillomavirus (HPV) vaccination have contributed to the reduced incidence of cervical cancer in developed countries [3,4,5]. Low-income countries have not had the same reduction in cervical cancer incidence as higher income countries [1]. Cervical cancer remains the second most common cancer affecting women
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