Abstract
BackgroundCancer of the uterine cervix is the leading cause of cancer-related death among women in Sub-Saharan Africa, but information from the Democratic Republic of the Congo (DRC) is scarce. The study objectives were to: 1/ assess prevalence of (pre)cancerous cervical lesions in adult women in Kinshasa, 2/ identify associated socio-demographic and behavioural factors and 3/ describe human papillomavirus (HPV) types in cervical lesions.MethodsA cross-sectional study was conducted in Kinshasa. Between 2006 and 2013, four groups of women were recruited. The first two groups were included at HIV screening centres. Group 1 consisted of HIV-positive and group 2 of HIV-negative women. Group 3 was included in large hospitals and group 4 in primary health centres. Pap smears were studied by monolayer technique (Bethesda classification). Low- or high-grade squamous intraepithelial lesions or carcinoma were classified as LSIL+. HPV types were determined by INNO-LiPA®. Bivariate and multivariable analyses (logistic regression and generalised estimating equations (GEE)) were used to assess associations between explanatory variables and LSIL+.ResultsLSIL+ lesions were found in 76 out of 1018 participants. The prevalence was 31.3 % in group 1 (n = 131 HIV-positive women), 3.9 % in group 2 (n = 128 HIV-negative women), 3.9 % in group 3 (n = 539) and 4.1 % in group 4 (n = 220). The following variables were included in the GEE model but did not reach statistical significance: history of abortion, ≥3 sexual partners and use of chemical products for vaginal care. In groups 3 and 4 where this information was available, the use of plants for vaginal care was associated with LSIL+ (adjusted OR 2.70 (95 % confidence interval 1.04 – 7.01). The most common HPV types among HIV-positive women with ASCUS+ cytology (ASCUS or worse) were HPV68 (12 out of 50 samples tested), HPV35 (12/50), HPV52 (12/50) and HPV16 (10/50). Among women with negative/unknown HIV status, the most common types were HPV52 (10/40), HPV35, (6/40) and HPV18 (5/40).ConclusionLSIL+ lesions are frequent among women in Kinshasa. The use of plants for vaginal care deserves attention as a possible risk factor for LSIL+. In this setting, HPV16 is not the most frequent genotype in samples of LSIL+ lesions.
Highlights
Cancer of the uterine cervix is the leading cause of cancer-related death among women in Sub-Saharan Africa, but information from the Democratic Republic of the Congo (DRC) is scarce
The prevalence of low- grade squamous intraepithelial lesions (LSIL)+ lesions ranged from approximately 4 % in women with unknown or negative HIV status to 31 % in HIV-positive women
The prevalence of LSIL+ lesions that we found in the current study in women with unknown or seronegative HIV status (4 %) is consistent with the few studies previously performed in Kinshasa (3 % and 5 %) [35, 36] and in Bukavu in the eastern part of the country (7 %) [37]
Summary
Cancer of the uterine cervix is the leading cause of cancer-related death among women in Sub-Saharan Africa, but information from the Democratic Republic of the Congo (DRC) is scarce. Cervical cancer constitutes a major health problem worldwide It is responsible for 530,000 new cases of cancer and causes 270,000 deaths each year [1, 2]. In Sub-Saharan Africa the incidence rate amounts to about 30–35, and here it is the most frequent cancer in women (for African data see [3,4,5,6]). It is expected, even on demographic grounds, that the burden of cervical cancer will further increase in Africa over the years [7]. Several other factors have been found to increase the risk of cervical cancer, possibly through their relation with the risk of HPV infection: number of sexual partners, early sexual activity [10], parity [11], long-term use of oral contraceptives [12,13,14], smoking [15] and HIV/AIDS [16,17,18]
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