Abstract
ObjectivesTo report the results of a pilot study for a service for cervical cancer screening and diagnosis in north-western Tanzania.MethodsThe pilot study was launched in 2012 after a community-level information campaign. Women aged 15–64 years were encouraged to attend the district health centres. Attendees were offered a conventional Pap smear and a visual inspection of the cervix with acetic acid (VIA).ResultsThe first 2500 women were evaluated. A total of 164 women (detection rate 70.0/1000) were diagnosed with high-grade cervical intraepithelial neoplasia and invasive cervical cancer. The performance of VIA was comparable to that of Pap smear. The district of residence, a history of untreated sexually transmitted disease, an HIV-negative status (inverse association), and parity were independently associated with the detected prevalence of disease. The probability of invasive versus preinvasive disease was lower in HIV-positive women and in women practicing breast self-examination.ConclusionsThe diagnostic procedure had an acceptable level of quality. Factors associated with the detected prevalence of disease will allow for a more targeted promotion of the service. Cervical screening should be coordinated with sexually transmitted disease and HIV infection control activities.
Highlights
In sub-Saharan Africa cervical cancer is the leading cause of cancer deaths, with an incidence of disease among the highest worldwide and one of the lowest 5-year survival rates (Jemal et al 2012; Parkin et al 2008; Sankaranarayanan et al 2010; Soerjomataram et al 2012)
The study rationale was twofold: first, we considered it necessary to obtain a field confirmation of the diagnostic performance of visual inspection with acetic acid (VIA) as reported in research settings (Sankaranarayanan et al 2003); and, second, we aimed to determine the demographic and health-related characteristics of patients that identify subsets of the population with higher prevalence of disease, invasive disease, in order to target them with greater screening intensity
The pilot study reported in this article was entirely selfmanaged by local staff after adequate training
Summary
In sub-Saharan Africa cervical cancer is the leading cause of cancer deaths, with an incidence of disease among the highest worldwide and one of the lowest 5-year survival rates (Jemal et al 2012; Parkin et al 2008; Sankaranarayanan et al 2010; Soerjomataram et al 2012). The major challenges to this come from the low level of education, limited human and financial resources, and poor professional/technical skills (Anorlu 2008; Fokom-Domgue et al 2014; Tekinturhan et al 2013). For these reasons, the provision of cervical cancer prevention services is far below the needs (Chigbu et al 2015). There are few population-based screening activities and none of sub-Saharan African countries has extended the provision of the service (Louie et al 2009; Mvundura and Tsu 2014)
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