Abstract
BackgroundIn 2007, the Cameroon Baptist Convention Health Services (CBCHS) implemented a screen-and-treat cervical cancer prevention program using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC).MethodsWe retrospectively analyzed 46,048 medical records of women who received care through the CBCHS Women’s Health Program from 2007 through 2014 to determine the prevalence and predictors of positive VIA-DC, rates of same day treatment, and cohort prevalence of invasive cervical cancer (ICC).ResultsOf the 44,979 women who were screened for cervical cancer, 9.0% were VIA-DC-positive, 66.8% were VIA-DC-negative, 22.0% were VIA-DC-inadequate (normal ectocervix, but portions of the transformation zone were obscured), and 2.2% were VIA-DC-uncertain (cervical abnormalities confounding VIA-DC interpretation). Risk factors significantly associated with VIA-DC-positive screen were HIV-positivity, young age at sexual debut, higher lifetime number of sexual partners, low education status and higher gravidity. In 2014, 31.1% of women eligible for cryotherapy underwent same day treatment. Among the 32,788 women screened from 2007 through 2013, 201 cases of ICC were identified corresponding to a cohort prevalence of 613 per 100,000.ConclusionsHigh rate of VIA-DC-positive screens suggests a significant burden of potential cervical cancer cases and highlights the need for expansion of cervical cancer screening and prevention throughout the 10 regions of Cameroon. VIA-DC-inadequate rates were also high, especially in older women, and additional screening methods are needed to confirm whether these results are truly negative. In comparison to similar screening programs in sub-Saharan Africa there was low utilization of same day cryotherapy treatment. Further studies are required to characterize possible program specific barriers to treatment, for example cultural demands, health system challenges and cost of procedure. The prevalence of ICC among women who presented for screening was high and requires further investigation.
Highlights
Invasive cervical cancer (ICC) is the leading cause of cancer mortality among women in subSaharan Africa (SSA) with approximately 99,000 new cases and 57,400 deaths in 2012 [1, 2]
Of the 44,979 women who were screened for cervical cancer, 9.0% were visual inspection with acetic acid (VIA)-DC-positive, 66.8% were VIA-DC-negative, 22.0% were VIA-DC-inadequate, and 2.2% were VIA-DC-uncertain
High rate of VIA-DC-positive screens suggests a significant burden of potential cervical cancer cases and highlights the need for expansion of cervical cancer screening and prevention throughout the 10 regions of Cameroon
Summary
Invasive cervical cancer (ICC) is the leading cause of cancer mortality among women in subSaharan Africa (SSA) with approximately 99,000 new cases and 57,400 deaths in 2012 [1, 2]. Owing to certain increased susceptibilities, women make up the majority of the HIV seropositive population in Africa [7], and nearly 40% of HIV seropositive women without visible cervical abnormalities test positive for HPV infection, increasing their risk for developing cervical intraepithelial neoplasia (CIN) or ICC [8] Despite their relative increased risk, less than 19% of women in developing countries have been screened for CIN even once in their lifetime [9]. ICC is reported as the second leading cause of cancer mortality and incidence among women in Cameroon by GLOBOCAN 2012 from the International Agency for Research on Cancer (IARC) (17.5 deaths per 100,000 per year and 30.0 cases per 100,000 per year) [2] This may be an underestimation due to the lack of specific country-level data on cervical cancer screening and the absence of a national cancer registry [1, 9, 29]. In 2007, the Cameroon Baptist Convention Health Services (CBCHS) implemented a screen-and-treat cervical cancer prevention program using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC)
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