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Lemma TM, Bala ET, Hordofa MA, Solbana LK. Precancerous cervical lesions and associated factors among women on antiretroviral therapy at Dukem Health Center, Central Ethiopia: A cross-sectional study. Health Sci Rep 2024; 7:e1972. [PMID: 38476585 PMCID: PMC10928928 DOI: 10.1002/hsr2.1972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Background and Aims Cervical cancer is a global public health problem and the second most common cancer which leads to morbidity and mortality among women in developing countries like Ethiopia. In Ethiopia, annually 6294 new cervical cancer cases and 4884 deaths are estimated in 2018 alone. This study aimed to assess the prevalence and associated factors of precancerous cervical lesions among women on antiretroviral therapy (ART) at Dukem Health Center, Central Ethiopia. Methods An institution-based cross-sectional study was carried out among randomly selected 257 women receiving ART at Dukem Health Center. Data were collected using a pretested structured questionnaire, medical record review, and visual inspection with acetic acid. Collected data were entered into Epi-info 7.4 and exported to SPSS version 26 for analysis. The prevalence of precancerous cervical lesions and the characteristics of study participants were identified. Utilizing both binary and multivariable logistic regression models, the existence and degree of association with precancerous cervical lesions were determined with a p value < 0.05 and a 95% confidence interval. Results The prevalence of precancerous cervical lesions was 16% (95% CI: 11.7-20.6). Significant association was found between precancerous cervical lesions and a history of STIs (AOR = 4.30, 95% CI: 1.48-12.49), oral contraceptive use (AOR = 6.56, 95% CI: 2.10-20.50), having multiple lifetime sexual partners (AOR = 2.53: 95% CI: 1.05-6.10), and a recent CD4 count of less than 200 cells/mm3 (AOR: 11.33, 95% CI: 2.88-24.58). Conclusion In the study area, the prevalence of precancerous cervical lesions was relatively high. Therefore, concerned bodies are recommended to increase awareness of the prevention of sexually transmitted diseases and limit sexual partners.
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Kaizilege GK, Ndaboine E, Chuma C, Mujuni F, Kiritta R, Matovelo D, Ottoman O, Elias E, Masalu N, Kidenya BR, Mazigo HD. Unraveling cervical cancer screening dilemmas: histopathological insights from VIA and LEEP at bugando medical centre, Mwanza. BMC Cancer 2024; 24:66. [PMID: 38216912 PMCID: PMC10785426 DOI: 10.1186/s12885-023-11779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The single-visit strategy, also known as the "screen-and-treat" approach, is widely used to screen for cervical cancer in low- and middle-income countries. The screen-and-treat approach leads to unnecessary or inadequate treatment. Thus, a study was conducted to determine the histopathological patterns of aceto-white lesions on visual inspection with acetic acid (VIA) in patients who underwent a Loop Electrosurgical Excision Procedure (LEEP) at Bugando Medical Centre between January 2016 and December 2020. METHOD A 5-year retrospective cross-sectional case record review was conducted on 329 women who had LEEP at Bugando Medical Centre following a positive VIA cervical screening test. A standard data abstraction form was used to collect patient information. Missing client information records and LEEP without histopathological results were exclusion criteria. For statistical analysis, STATA version 15 was used; in descriptive statistics, frequency, mean, and standard deviation were used. The Chi2 and Fisher's exact tests were used to investigate the relationship between patient characteristics and histopathological patterns, and a P-value of 0.05 was considered statistically significant in multinomial models. RESULTS This study looked at 329 patients who had LEEP following a VIA positive but were not eligible for cryotherapy. Our study participants had a mean age of 40 ± 8.2 SD. There were 203 (61.7%) patients with benign lesions, including 4 with schistosomiasis and 2 with cervical tuberculosis. The precancerous lesions were discovered in 100 cases (30.4%), and 26 (7.9%) already had invasive cervical cancer. Out of 100 patients with precancerous lesions, 58 (17.6%) and 42 (12.8%) have high- and low-grade squamous intraepithelial (HSIL and LSIL) lesions, respectively. The presence of a precancerous lesion was found to be associated with age 31-40 years (P-value 0.042) and HIV positivity (P-value 0.004). CONCLUSION Most patients in this study had benign cervical lesions, which do not require LEEP treatment. Nonetheless, a considerable percentage of invasive cervical malignancies and rare benign diseases such as schistosomiasis and cervical tuberculosis were identified. A screen-and-treat approach within well-equipped tertiary hospitals like Bugando Medical Centre should explore alternative options instead of relying solely on straight LEEP.
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Affiliation(s)
- Godfrey K Kaizilege
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Edgar Ndaboine
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania.
| | - Clotilda Chuma
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Fridolin Mujuni
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Richard Kiritta
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Dismas Matovelo
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Oscar Ottoman
- Department of Pathology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Edrick Elias
- Department of Pathology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Nestory Masalu
- Department of Oncology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Benson R Kidenya
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Humphrey D Mazigo
- Department of Parasitology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
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Parham GP, Egemen D, Befano B, Mwanahamuntu MH, Rodriguez AC, Antani S, Chisele S, Munalula MK, Kaunga F, Musonda F, Malyangu E, Shibemba AL, de Sanjose S, Schiffman M, Sahasrabuddhe VV. Validation in Zambia of a cervical screening strategy including HPV genotyping and artificial intelligence (AI)-based automated visual evaluation. Infect Agent Cancer 2023; 18:61. [PMID: 37845724 PMCID: PMC10580629 DOI: 10.1186/s13027-023-00536-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/13/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND WHO has recommended HPV testing for cervical screening where it is practical and affordable. If used, it is important to both clarify and implement the clinical management of positive results. We estimated the performance in Lusaka, Zambia of a novel screening/triage approach combining HPV typing with visual assessment assisted by a deep-learning approach called automated visual evaluation (AVE). METHODS In this well-established cervical cancer screening program nested inside public sector primary care health facilities, experienced nurses examined women with high-quality digital cameras; the magnified illuminated images permit inspection of the surface morphology of the cervix and expert telemedicine quality assurance. Emphasizing sensitive criteria to avoid missing precancer/cancer, ~ 25% of women screen positive, reflecting partly the high HIV prevalence. Visual screen-positive women are treated in the same visit by trained nurses using either ablation (~ 60%) or LLETZ excision, or referred for LLETZ or more extensive surgery as needed. We added research elements (which did not influence clinical care) including collection of HPV specimens for testing and typing with BD Onclarity™ with a five channel output (HPV16, HPV18/45, HPV31/33/52/58, HPV35/39/51/56/59/66/68, human DNA control), and collection of triplicate cervical images with a Samsung Galaxy J8 smartphone camera™ that were analyzed using AVE, an AI-based algorithm pre-trained on a large NCI cervical image archive. The four HPV groups and three AVE classes were crossed to create a 12-level risk scale, ranking participants in order of predicted risk of precancer. We evaluated the risk scale and assessed how well it predicted the observed diagnosis of precancer/cancer. RESULTS HPV type, AVE classification, and the 12-level risk scale all were strongly associated with degree of histologic outcome. The AVE classification showed good reproducibility between replicates, and added finer predictive accuracy to each HPV type group. Women living with HIV had higher prevalence of precancer/cancer; the HPV-AVE risk categories strongly predicted diagnostic findings in these women as well. CONCLUSIONS These results support the theoretical efficacy of HPV-AVE-based risk estimation for cervical screening. If HPV testing can be made affordable, cost-effective and point of care, this risk-based approach could be one management option for HPV-positive women.
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Affiliation(s)
- Groesbeck P Parham
- Women and Newborn Hospital, University Teaching Hospital, Lusaka, Zambia.
| | - Didem Egemen
- HPV-AVE (PAVE) Initiative, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20850, USA
| | - Brian Befano
- Information Management Services Inc, Calverton, MD, USA
| | | | - Ana Cecilia Rodriguez
- HPV-AVE (PAVE) Initiative, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20850, USA
| | - Sameer Antani
- National Library of Medicine, NIH, Bethesda, MD, 20892, USA
| | - Samson Chisele
- Women and Newborn Hospital, University Teaching Hospital, Lusaka, Zambia
| | | | - Friday Kaunga
- Women and Newborn Hospital, University Teaching Hospital, Lusaka, Zambia
| | - Francis Musonda
- Women and Newborn Hospital, University Teaching Hospital, Lusaka, Zambia
| | - Evans Malyangu
- Women and Newborn Hospital, University Teaching Hospital, Lusaka, Zambia
| | | | - Silvia de Sanjose
- HPV-AVE (PAVE) Initiative, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20850, USA
| | - Mark Schiffman
- HPV-AVE (PAVE) Initiative, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20850, USA.
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Hicks MM, Chanda K, Mwanahamuntu M, Jones MB, Mattison AR, Pfaendler KS, Pinder LF, Parham GP, Hicks ML. Comparison of a U.S. and Zambian Ob/Gyn Residency Training Programme. Ecancermedicalscience 2022; 16:1468. [PMID: 36819817 PMCID: PMC9934879 DOI: 10.3332/ecancer.2022.1468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction The major objective of the study was to compare and contrast a U.S. and Zambian Ob/Gyn residency programme, using uniform metrics, as the basis for an initial exploration of perceived inequities in post-graduate medical education between low- and high-income countries. Methods Measurements of the following procedures were used to indicate whether minimum standards had been met by trainees in their respective postgraduate programmes: vaginal deliveries; C-sections; abdominal, vaginal and laparoscopic hysterectomies; other laparoscopic surgeries; cancer cases; abortions; obstetrical ultrasounds; cystoscopies; incontinence and pelvic floor surgeries. Evaluations were also made with respect to the presence or absence of an official ultrasound rotation, subspeciality and off-service rotations, protected didactic time and exclusive time on obstetrics and gynaecologic clinical services. Comparisons were made relative to these various categories and the average procedural numbers at each level of training to determine differences in trends and degree of exposure. Results Minimal procedural requirements were met by both the U.S. and Zambian programmes. For open surgical cases, the minimum standards were higher for the Zambian programme, whereas for procedures associated with the use of high-end technology, such as ultrasound and minimally invasive surgery, minimum standards were higher for the U.S. programme. Conclusion There were no significant differences in the Zambian and U.S. Ob/Gyn post-graduate training programmes, relative to their respective metrics. A more extensive analysis is required to determine the actual competency levels that are produced by the respective training systems.
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Affiliation(s)
- Maya M Hicks
- Department of Obstetrics and Gynecology, Anne Arundel Medical Center, 2000 Medical Pkwy, Belcher Pavilion, Ste 309, Annapolis, MD 21401, USA,https://orcid.org/0000-0002-1993-3367
| | - Kenneth Chanda
- Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
| | - Monica B Jones
- Department of Obstetrics and Gynecology, Anne Arundel Medical Center, 2000 Medical Pkwy, Belcher Pavilion, Ste 309, Annapolis, MD 21401, USA
| | - Anissa R Mattison
- Trinity Health Academic Obstetrics and Gynecology, 44428 Woodward Ave Ste 104, Pontiac, MI 48341, USA
| | - Krista S Pfaendler
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, 64 Medical Center Drive, Morgantown, WV 26506, USA
| | - Leeya F Pinder
- Department of Oncology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA,https://orcid.org/0000-0002-8929-7810
| | - Groesbeck P Parham
- Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia,Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr., Chapel Hill, NC 27514, USA,https://orcid.org/0000-0001-5922-5990
| | - Michael L Hicks
- Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia,Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr., Chapel Hill, NC 27514, USA,St. Joseph Mercy Oakland, Michigan Cancer Center, 44405 Woodward Ave, Suite 202, Pontiac, MI 48341, USA,https://orcid.org/0000-0002-1819-155X
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Zelalem W, Weldegebreal F, Ayele BH, Deressa A, Debella A, Eyeberu A, Hassen FA, Dessie Y. Precancerous Cervical Lesion Among Adult Women With Human Immune Deficiency Virus on Anti Retroviral Therapy At Saint Peter Specialized Hospital, Ethiopia: A Hospital-Based Cross-Sectional Study. Front Oncol 2022; 12:910915. [PMID: 35957869 PMCID: PMC9361014 DOI: 10.3389/fonc.2022.910915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/31/2022] [Indexed: 12/24/2022] Open
Abstract
Background Cervical cancer is the fourth most frequent cancer in women representing 6.6% of all female cancers occurring in low and middle-income countries, where resources for cancer prevention programs are often scarce. So this study aimed to assess the prevalence of precancerous cervical lesion and associated factors among adult women with human immune deficiency virus (HIV) on Anti Retroviral Therapy (ART) at Saint Peter Specialized Hospital, Addis Ababa, Ethiopia. Methods An institution-based cross-sectional study was conducted from November 06 to July 20, 2020 among 267 adult women with HIV on Anti Retroviral Therapy At Saint Peter Specialized Hospital, Ethiopia. Data were collected using face-to-face interview, patient chart review, and the examination of the squamo-columnar junction by the visual inspection with the acetic acid method. The collected data were entered into Epi-data version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 24.0 for analysis. Bivariate and multivariable binary logistic regression analysis were used to identify factors associated with the precancerous cervical lesion. Statistical significance was considered at a P-valve less than 0.05. Result A total of 267 women who were on ART were included in the study and the prevalence of precancerous cervical lesion was 7.5% with 95% CI =4.10%-10.50%. Modern family planning (AOR = 4.14, 95% CI = 1.23-13.87), history of sexual transmission infection (STI) (AOR=5.39, 95% CI= 1.56-18.70) and viral load (AOR=20.85, 95% CI = 6.19-70.25) had significant association with precancerous cervical lesion Conclusion In this study, the prevalence of precancerous cervical lesion is relatively low compared to studies in low and middle-income countries. Modern family planning, history of sexual transmitted infection, and viral load had a significant association with a precancerous cervical lesion. Hence, encouraging modern family planning, and routine screening of women for pre-cancerous cervical lesions for those with high viral load have enormous contributions to decreasing cervical cancer disease among Women with Human Immune Deficiency Virus through Anti Retroviral Therapy.
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Affiliation(s)
- Wondimu Zelalem
- School of Public Health, Saint Peter Specialized Hospital, Addis Ababa, Ethiopia
| | - Fitsum Weldegebreal
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- *Correspondence: Fitsum Weldegebreal, ; orcid.org/0000-0002-78671483-a
| | - Behailu Hawulte Ayele
- Department of Public Health and Health Policy, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Alemayehu Deressa
- Department of Public Health and Health Policy, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fila Ahmed Hassen
- Department of Public Health and Health Policy, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- Department of Public Health and Health Policy, School of Public Health, Haramaya University, Harar, Ethiopia
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Musekiwa A, Moyo M, Mohammed M, Matsena-Zingoni Z, Twabi HS, Batidzirai JM, Singini GC, Kgarosi K, Mchunu N, Nevhungoni P, Silinda P, Ekwomadu T, Maposa I. Mapping Evidence on the Burden of Breast, Cervical, and Prostate Cancers in Sub-Saharan Africa: A Scoping Review. Front Public Health 2022; 10:908302. [PMID: 35784211 PMCID: PMC9246362 DOI: 10.3389/fpubh.2022.908302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCancer remains a major public health problem, especially in Sub-Saharan Africa (SSA) where the provision of health care is poor. This scoping review mapped evidence in the literature regarding the burden of cervical, breast and prostate cancers in SSA.MethodsWe conducted this scoping review using the Arksey and O'Malley framework, with five steps: identifying the research question; searching for relevant studies; selecting studies; charting the data; and collating, summarizing, and reporting the data. We performed all the steps independently and resolved disagreements through discussion. We used Endnote software to manage references and the Rayyan software to screen studies.ResultsWe found 138 studies that met our inclusion criteria from 2,751 studies identified through the electronic databases. The majority were retrospective studies of mostly registries and patient files (n = 77, 55.8%), followed by cross-sectional studies (n = 51, 36.9%). We included studies published from 1990 to 2021, with a sharp increase from 2010 to 2021. The quality of studies was overall satisfactory. Most studies were done in South Africa (n = 20) and Nigeria (n = 17). The majority were on cervical cancer (n = 93, 67.4%), followed by breast cancer (67, 48.6%) and the least were on prostate cancer (48, 34.8%). Concerning the burden of cancer, most reported prevalence and incidence. We also found a few studies investigating mortality, disability-adjusted life years (DALYs), and years of life lost (YLL).ConclusionsWe found many retrospective record review cross-sectional studies, mainly in South Africa and Nigeria, reporting the prevalence and incidence of cervical, breast and prostate cancer in SSA. There were a few systematic and scoping reviews. There is a scarcity of cervical, breast and prostate cancer burden studies in several SSA countries. The findings in this study can inform policy on improving the public health systems and therefore reduce cancer incidence and mortality in SSA.
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Affiliation(s)
- Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- *Correspondence: Alfred Musekiwa
| | - Maureen Moyo
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Mohanad Mohammed
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Zvifadzo Matsena-Zingoni
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jesca Mercy Batidzirai
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - Kabelo Kgarosi
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nobuhle Mchunu
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Portia Nevhungoni
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
| | - Patricia Silinda
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Theodora Ekwomadu
- Department of Biological Sciences, Faculty of Natural and Agricultural Sciences, North-West University, Mmabatho, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Trejo MJ, Soliman AS, Chen Y, Kalima M, Chuba A, Chama E, Mwaba CK, Banda L, Lishimpi K. Effects of HIV infection on metastatic cervical cancer and age at diagnosis among patients in Lusaka, Zambia. Int J Gynaecol Obstet 2022; 156:521-528. [PMID: 34121186 PMCID: PMC8669036 DOI: 10.1002/ijgo.13784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/12/2021] [Accepted: 06/11/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the association between the duration of HIV infection and the stage of cervical cancer in Lusaka, Zambia. METHODS This retrospective case-case study included 1583 cervical cancer patients from the Cancer Diseases Hospital in Lusaka, Zambia. A sub-population of HIV-positive patients with additional clinical HIV information was identified following linkage of cancer and HIV databases. Logistic regression models examined the relationship between HIV status and early-onset cervical cancer diagnosis, and between HIV infection duration and initial diagnosis of metastatic cervical cancer. RESULTS The study population had an average age of 49 years and 40.9% had an initial diagnosis of metastatic cancer. HIV-positive women were more than twice as likely to be diagnosed at early-onset cervical cancer compared with HIV-negative women. Among the sub-population of HIV-positive patients, a longer duration of HIV infection was associated with 20% lowered odds of initial metastatic cancer diagnosis. CONCLUSION The availability, accessibility, and impact of the cervical screening program in this population should be further examined to elucidate the relationship between cervical screening, age, and duration of HIV infection and the the stage of diagnosis of cervical cancer.
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Affiliation(s)
- Mario Jesus Trejo
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - Amr S. Soliman
- Department of Community Health and Social Medicine, School of Medicine, The City College of New York, New York, NY, USA,Correspondence Amr S. Soliman, City University of New York School of Medicine, New York, NY, USA.
| | - Yuli Chen
- Department of Epidemiology, Colorado School of Public Health, University of Colorado
| | - Mulele Kalima
- University Teaching Hospital – HIV/AIDS Program, Lusaka, Zambia
| | - Alick Chuba
- University Teaching Hospital – HIV/AIDS Program, Lusaka, Zambia
| | - Eslone Chama
- University Teaching Hospital – HIV/AIDS Program, Lusaka, Zambia
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Smartphone-Based Visual Inspection with Acetic Acid: An Innovative Tool to Improve Cervical Cancer Screening in Low-Resource Setting. Healthcare (Basel) 2022; 10:healthcare10020391. [PMID: 35207002 PMCID: PMC8871553 DOI: 10.3390/healthcare10020391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/06/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Visual inspection with acetic acid (VIA) is recommended by the World Health Organization for primary cervical cancer screening or triage of human papillomavirus-positive women living in low-resource settings. Nonetheless, traditional VIA with the naked-eye is associated with large variabilities in the detection of pre-cancer and with a lack of quality control. Digital-VIA (D-VIA), using high definition cameras, allows magnification and zooming on transformation zones and suspicious cervical regions, as well as simultaneously compare native and post-VIA images in real-time. We searched MEDLINE and LILACS between January 2015 and November 2021 for relevant studies conducted in low-resource settings using a smartphone device for D-VIA. The aim of this review was to provide an evaluation on available data for smartphone use in low-resource settings in the context of D-VIA-based cervical cancer screenings. The available results to date show that the quality of D-VIA images is satisfactory and enables CIN1/CIN2+ diagnosis, and that a smartphone is a promising tool for cervical cancer screening monitoring and for on- and off-site supervision, and training. The use of artificial intelligence algorithms could soon allow automated and accurate cervical lesion detection.
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Comparative assessment of test characteristics of cervical cancer screening methods for implementation in low-resource settings. Prev Med 2022; 154:106883. [PMID: 34785209 DOI: 10.1016/j.ypmed.2021.106883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 12/31/2022]
Abstract
Cervical cancer disproportionately affects low-resource settings. Papanicolaou, human papillomavirus (HPV), and visual inspection of cervix with acetic acid (VIA) testing, each with different characteristics, will reduce cervical cancer burden. We conducted a critical literature review using PubMed, Cochrane, WHO, and grey literature from 1994 to 2020. We examined efficacy, harms, and comparative effectiveness of screening methods by age, human immunodeficiency virus, provider characteristics, and assessed implementation challenges in low-resource settings. Comprehensive data on utility and efficacy of screening tests indicates that each screening has strengths and shortcomings but all confer acceptable performance. HPV and VIA appear more promising. Primary HPV test-and-treat, self-testing, and co-testing have been studied but data on triage plans, cost, support system, implementation and sustainability is unclear in low-resource settings. HPV testing could help target subgroups of older or higher risk women. VIA offers local capacity-building and scalability. Quality VIA technique after HPV testing is still required to guide post-screening treatments. VIA competencies decline gradually with current standard trainings. Stationary cervicography improves VIA quality but isn't scalable. Affordable smartphones eliminate this barrier, enhance training through mentorship, and advance continuing education and peer-to-peer training. Smartphone-based VIA facilitates cervical image storage for patient education, health promotion, record-keeping, follow-up care, remote expert support, and quality control to improve VIA reliability and reproducibility and reduce mis-diagnoses and burden to health systems. Rather than ranking screening methods using test characteristics alone in study or higher-resource settings, we advocate for scalable strategies that maximize reliability and access and reduce cost and human resources.
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Taghavi K, Moono M, Mwanahamuntu M, Basu P, Limacher A, Tembo T, Kapesa H, Hamusonde K, Asangbeh S, Sznitman R, Low N, Manasyan A, Bohlius J. Screening test accuracy to improve detection of precancerous lesions of the cervix in women living with HIV: a study protocol. BMJ Open 2020; 10:e037955. [PMID: 33371015 PMCID: PMC7751198 DOI: 10.1136/bmjopen-2020-037955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The simplest and cheapest method for cervical cancer screening is visual inspection after application of acetic acid (VIA). However, this method has limitations for correctly identifying precancerous cervical lesions (sensitivity) and women free from these lesions (specificity). We will assess alternative screening methods that could improve sensitivity and specificity in women living with humanimmunodeficiency virus (WLHIV) in Southern Africa. METHODS AND ANALYSIS We will conduct a paired, prospective, screening test accuracy study among consecutive, eligible women aged 18-65 years receiving treatment for HIV/AIDS at Kanyama Hospital, Lusaka, Zambia. We will assess a portable magnification device (Gynocular, Gynius Plus AB, Sweden) based on the Swede score assessment of the cervix, test for high-risk subtypes of human papillomavirus (HR-HPV, GeneXpert, Cepheid, USA) and VIA. All study participants will receive all three tests and the reference standard at baseline and at six-month follow-up. The reference standard is histological assessment of two to four biopsies of the transformation zone. The primary histological endpoint is cervical intraepithelial neoplasia grade two and above (CIN2+). Women who are VIA-positive or have histologically confirmed CIN2+ lesions will be treated as per national guidelines. We plan to enrol 450 women. Primary outcome measures for test accuracy include sensitivity and specificity of each stand-alone test. In the secondary analyses, we will evaluate the combination of tests. Pre-planned additional studies include use of cervigrams to test an automated visual assessment tool using image pattern recognition, cost-analysis and associations with trichomoniasis. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Zambia Biomedical Research Ethics Committee, Zambian National Health Regulatory Authority, Zambia Medicines Regulatory Authority, Swissethics and the International Agency for Research on Cancer Ethics Committee. Results of the study will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03931083; Pre-results.
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Affiliation(s)
- Katayoun Taghavi
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Misinzo Moono
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Mulindi Mwanahamuntu
- Obstetrics and Gynaecology, University Teaching Hospital, Lusaka, Zambia
- Women and Newborn health, Levy Mwanawasa Medical University Hospital, Lusaka, Zambia
| | - Partha Basu
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | | | - Taniya Tembo
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Herbert Kapesa
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Kalongo Hamusonde
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Serra Asangbeh
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Raphael Sznitman
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Albert Manasyan
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Julia Bohlius
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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11
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Retrospective Review of Loop Electrosurgical Excision Procedure (LEEP) Outcomes at a Tertiary Hospital in Zambia. Obstet Gynecol Int 2020; 2020:1920218. [PMID: 32922449 PMCID: PMC7453247 DOI: 10.1155/2020/1920218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 06/19/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022] Open
Abstract
There is a lack of knowledge on the histologic outcomes of loop electrosurgical excision procedure (LEEP) biopsies in the diagnosis, treatment, and prevention of cervical cancer in Zambia. This study determined the outcomes of LEEP biopsies and associated factors at a tertiary hospital. We conducted a retrospective chart review of patients evaluated at a tertiary hospital cervical cancer screening centre. From the database, we identified patients who underwent LEEP between January 2015 and June 2018. We extracted demographic data, HIV data, and LEEP biopsy results. A P value less than 0.05 was considered statistically significant. 137 charts were identified, and 114 were included in the final analysis. 23 were excluded for missing histology. The mean age of participants was 36.3 ± 9.6. Histology outcomes revealed that 37% had cervicitis, while CIN 1, 2, and 3 contributed to 27%, 14%, and 3%, respectively. Squamous cell cancer was present in 8% (age groups 35-49) and was three times higher (13%) in HIV-positive compared to HIV-negative participants (3.8%). Normal histology accounted for 11%. Increasing age (P=0.029), less than tertiary education (P=0.0011), and being married (P=0.017) increased the chances of having cancer in the chi-square analysis, while single women had lower odds of having CIN 1 (OR = 0.012) in the multinomial logistic regression. There is a need for increased cervical cancer screening and training in precancer treatment and holistic consideration of other factors like age in addition to the positive VIA test in advising patients on treatment options.
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12
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Nyambe N, Hoover S, Pinder LF, Chibwesha CJ, Kapambwe S, Parham G, Subramanian S. Differences in Cervical Cancer Screening Knowledge and Practices by HIV Status and Geographic Location: Implication for Program Implementation in Zambia. Afr J Reprod Health 2019; 22:92-101. [PMID: 30632726 DOI: 10.29063/ajrh2018/v22i4.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The knowledge and perceptions of cervical cancer among HIV negative and positive women, aged 25-49 years, from rural and urban locations in Zambia was systematically accessed in this study to determine any differences. Data were coded and analyzed using NVivo software. Compared to HIV negative women, HIV positive women had more accurate information about cervical cancer. They were more likely to cite male circumcision as the best approach to cervical cancer prevention. HPV infection was more commonly mentioned as a risk factor among HIV positive women. However, HIV positive women displayed little knowledge about HPV being the major cause of cervical cancer. Among HIV positive women, lack of time was the major screening barrier cited while HIV negative women mentioned being symptomatic as a determinant for early detection. Compared to rural residents, urban residents cited a wider range of cervical cancer information sources, including media and workplace although all of the participants who stated that they had no knowledge of cervical cancer were urban residents. Overall, knowledge and perceptions of cervical cancer among study participants was high, although differences exist between subgroups. Sharing accurate and standardized information on cervical cancer would improve participation in cervical cancer screening services.
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Affiliation(s)
| | | | - Leeya F Pinder
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
| | - Carla J Chibwesha
- UNC Global Projects- Zambia.,Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
| | | | - Groesbeck Parham
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
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13
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Maliti B, Mbozi P. Disease Comanagement: A Case Study of HIV/AIDS and Cancer Care in Sub-Saharan Africa. Clin J Oncol Nurs 2019; 22:228-231. [PMID: 29547599 DOI: 10.1188/18.cjon.228-231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer care is increasingly complicated worldwide by its management with concurrent acute and chronic illness states. In low- and middle-income countries, including those in sub-Saharan Africa, this results in lower overall survival rates and a higher burden of cancer deaths. A case study is presented to highlight the challenges patients with cancer in Zambia-many of whom are also positive for HIV or AIDS-face in relationship to access to care and comanagement of disease states.
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14
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Einstein MH, Ndlovu N, Lee J, Stier EA, Kotzen J, Garg M, Whitney K, Lensing SY, Tunmer M, Kadzatsa W, Palefsky J, Krown SE. Cisplatin and radiation therapy in HIV-positive women with locally advanced cervical cancer in sub-Saharan Africa: A phase II study of the AIDS malignancy consortium. Gynecol Oncol 2019; 153:20-25. [PMID: 30773222 DOI: 10.1016/j.ygyno.2019.01.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To determine the feasibility, safety, and tolerability of concomitant chemoradiotherapy administered at standard doses in HIV-infected women with locally-advanced cervical cancer (LACC) receiving antiretroviral therapy (ART). PATIENTS AND METHODS Eligible participants had HIV infection and untreated, histologically-confirmed, invasive carcinoma of the uterine cervix, FIGO stages IB2, IIA (if tumor >4 cm), IIB, IIIA, IIIB, or IVA and met standard eligibility criteria. Subjects were prescribed 41.4-45 Gy external beam radiation therapy followed by high dose rate brachytherapy concomitant with up to six weekly doses of cisplatin 40 mg/m2 and were followed for 12 months. RESULTS Sixty-four women were screened at two sites in sub-Saharan Africa, of whom 40 eligible participants were enrolled, for a screening ratio of 1.60. Of the 38 eligible participants who initiated study treatment, 31 (82%) completed treatment. By the 12-month follow-up visit, 7 women had died of disease and 29 of 31 (94%) returned for follow-up. One-year progression-free survival was 76.3% (95% CI, 59.4-86.9%), and did not significantly differ according to stage at entry (p = 0.581). Participant-reported adherence to ART was high; by 12 months, 93% of participants had an undetectable viral load. The most common grade 3 or 4 adverse event was decreased lymphocyte count that affected all treated participants. Non-hematologic serious adverse events were similar to those observed in women with LACC without HIV infection. CONCLUSIONS The majority of HIV-infected women with LACC can complete concomitant chemoradiotherapy with the same cisplatin dose used in HIV-uninfected women with comparable tolerability and high ART adherence while on treatment.
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Affiliation(s)
- Mark H Einstein
- Department of Obstetrics, Gynecology, & Women's Health, Rutgers New Jersey Medical School, Newark, NJ, United States of America.
| | - Ntokozo Ndlovu
- College of Health Sciences, University of Zimbabwe Harare, Zimbabwe
| | - Jeannette Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - Elizabeth A Stier
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States of America.
| | - Jeffrey Kotzen
- Department of Radiation Oncology, University of the Witwatersrand, Johannesburg, South Africa.
| | - Madhur Garg
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, United States of America.
| | - Kathleen Whitney
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, United States of America.
| | - Shelly Y Lensing
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - Mariza Tunmer
- Radiation Oncology Wits Donald Gordon Medical Centre, Johannesburg, South Africa.
| | - Webster Kadzatsa
- Department Radiotherapy and Oncology, College of Health Science University of Zimbabwe, Harare, Zimbabwe
| | - Joel Palefsky
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America.
| | - Susan E Krown
- AIDS Malignancy Consortium, New York, NY, United States of America.
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15
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Kapambwe S, Mwanahamuntu M, Pinder LF, Chisele S, Chirwa SC, Parham GP. Partnering with traditional Chiefs to expand access to cervical cancer prevention services in rural Zambia. Int J Gynaecol Obstet 2019; 144:297-301. [PMID: 30580443 DOI: 10.1002/ijgo.12750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/09/2018] [Accepted: 12/20/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate how the influence of traditional Chiefs can be leveraged to promote access to cervical cancer prevention services in rural Zambia. METHODS A retrospective review of outcome data was conducted for all screening outreach events that occurred in Zambian Chiefdoms between October 4, 2015, and October 3, 2016. Members of the health promotion team of the Cervical Cancer Prevention Program in Zambia visited local Chiefs to inform them of the importance of cervical cancer prevention. The local Chiefs then summoned adults living within their Chiefdoms to assemble for cervical cancer prevention health talks. Screen-and-treat services were implemented within each of the Chiefdoms over a 1-week period. RESULTS VIA-enhanced digital imaging of the cervix (digital cervicography) was offered to 8399 women in ten Chiefdoms as part of a village-based screening (VBS) program. In all, 419 (4.9%) women had positive screening test results. Of these women, 276 (65.8%) were treated immediately with thermocoagulation and 143 (34.1%) were referred to provincial government hospitals to undergo either the loop electrosurgical excision procedure/large loop excision of the transformation zone (n=109, 26.0%) or punch biopsy (n=34, 8.1%). CONCLUSION The influence of traditional Chiefs was leveraged to facilitate access to cervical cancer prevention services in rural Zambia.
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Affiliation(s)
- Sharon Kapambwe
- Ministry of Health, Republic of Zambia, Lusaka, Zambia.,Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynecology, Women and Newborn Hospital, Lusaka, Zambia
| | - Leeya F Pinder
- Department of Obstetrics and Gynecology, Women and Newborn Hospital, Lusaka, Zambia.,Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samson Chisele
- Department of Obstetrics and Gynecology, Women and Newborn Hospital, Lusaka, Zambia
| | - Susan C Chirwa
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, Women and Newborn Hospital, Lusaka, Zambia.,Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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16
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Demonstration of an algorithm to overcome health system-related barriers to timely diagnosis of breast diseases in rural Zambia. PLoS One 2018; 13:e0196985. [PMID: 29746541 PMCID: PMC5945023 DOI: 10.1371/journal.pone.0196985] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 04/24/2018] [Indexed: 01/07/2023] Open
Abstract
Background Long delays to diagnosis is a major cause of late presentation of breast diseases in sub-Saharan Africa. Aims We designed and implemented a single-visit breast care algorithm that overcomes health system-related barriers to timely diagnosis of breast diseases. Methods A multidisciplinary team of Zambian healthcare experts trained a team of mid- and high-level Zambian healthcare practitioners how to evaluate women for breast diseases, and train trainers to do likewise. Working collaboratively, the two teams then designed a clinical platform that provides multiple breast care services within a single visit. The service platform was implemented using a breast outreach camp format, during which breast self-awareness, psychosocial counseling, clinical breast examination, breast ultrasound, ultrasound-guided biopsy, imprint cytology of biopsy specimens and surgical treatment or referral, were offered within a single visit. Results Eleven hundred and twenty-nine (1129) women attended the camps for breast care. Mean age was 35.9 years. The majority were multiparous (79.4%), breast-fed (76.0%), and reported hormone use (50.4%). Abnormalities were detected on clinical breast examination in 122 (10.8%) women, 114 of whom required ultrasound. Of the 114 who underwent ultrasound, 48 had identifiable lesions and were evaluated with ultrasound-guided core needle biopsy (39) or fine-needle aspiration (9). The concordance between imprint cytology and histopathology was 100%, when breast specimens were classified as either benign or malignant. However, when specimens were classified by histopathologic subtype, the concordance between imprint cytology and histology was 85.7% for benign and 100% for malignant lesions. Six (6) women were diagnosed with invasive cancer. Eighteen (18) women with symptomatic breast lesions had next-day surgery. Significance Similar to its impact on cervical cancer prevention services, a single visit breast care algorithm has the potential to overcome health system-related barriers to timely diagnosis of breast diseases, including cancer, in rural African settings.
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17
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Yu L, Jiang M, Qu P, Wu Z, Sun P, Xi M, Qin Y, Liu X, Liao G, Lei X, Sun L, Zhang Y, Li Z, Chen W, Qiao YL. Clinical evaluation of human papillomavirus 16/18 oncoprotein test for cervical cancer screening and HPV positive women triage. Int J Cancer 2018. [PMID: 29524206 DOI: 10.1002/ijc.31368] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
HPV-16 and -18 account for about 80% of cervical cancers. We evaluated the performance of HPV-16/18 oncoprotein to predict precancer and cancer in corresponding tissue biopsy specimens. 1,008 women attending cervical cancer screening program and 638 women referred to colposcopy with biopsy-confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) from 4 hospitals were recruited (1,646 in total). All women were tested OncoE6 (AVC), Liquid-Based Cytology (Hologic) and cobas HPV test (Roche). Colposcopy was performed on women with any abnormal results. The final diagnoses were based on a consensus panel review of the histology. There were 919 normal, 69 CIN1, 53 CIN2, 91 CIN3,474 squamous cell carcinoma(SCC) and 40 adenocarcinoma (ADC) cases, the prevalence of OncoE6 was 1.7%, 10.1%, 13.2%, 44.0%, 80.4% and 65.0%, respectively. The percent positive for cobas was higher than that of OncoE6 in detection of HPV16/18 in entire population (p < 0.001). However, the disparity of positive rate between these two tests became tiny among cervical cancer patients (CIN2: 26.4% vs. 13.2%, CIN3: 73.6% vs. 44.0%, SCC: 84.0% vs. 80.4%, ADC: 67.5% vs. 65.0%). OncoE6 was less sensitive than cobas (73.9% vs. 93.6%, p < 0.001), but more specific (97.1% vs. 75.4%, p < 0.001) for CIN3+ in entire population; OncoE6 yielded a sensitivity of 77.7% and a specificity of 91.0% for CIN3+ among cobas positive women, which can reduce nearly half of the colposcopy referral numbers. OncoE6 can be considered as a useful tool for cervical cancer screening and a potential powerful biomarker for HPV positive triage.
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Affiliation(s)
- Lulu Yu
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.,Tumor Virus RNA Biology Section, RNA Biology Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD
| | - Mingyue Jiang
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Pengpeng Qu
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, People's Republic of China
| | - Zeni Wu
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Peisong Sun
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, People's Republic of China
| | - Mingrong Xi
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital, Medical College, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yu Qin
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Xin Liu
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Guangdong Liao
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital, Medical College, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiaoqin Lei
- Department of Clinical Nutrition, Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei, People's Republic of China
| | - Lixin Sun
- Department of Gynecological Oncology, Shanxi Cancer Hospital, Taiyuan, Shanxi, People's Republic of China
| | - Yongzhen Zhang
- Department of Epidemiology, Shanxi Cancer Hospital, Taiyuan, Shanxi, People's Republic of China
| | - Zhifang Li
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.,The Public Health and Prevent Department, Changzhi Medical College, Changzhi, People's Republic of China
| | - Wen Chen
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - You-Lin Qiao
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
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18
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Clinical Performance Validation of 4 Point-of-Care Cervical Cancer Screening Tests in HIV-Infected Women in Zambia. J Low Genit Tract Dis 2017; 20:218-23. [PMID: 27030883 DOI: 10.1097/lgt.0000000000000206] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to determine the clinical performance of visual inspection with acetic acid (VIA), digital cervicography (DC), Xpert human papillomavirus (HPV), and OncoE6 for cervical cancer screening in an HIV-infected population. MATERIALS AND METHODS HIV-infected women 18 years or older were included in this cross-sectional validation study conducted in Lusaka, Zambia. The screening tests were compared against a histological gold standard. We calculated sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and odds ratios using cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) and grade 3 or worse (CIN 3+) thresholds. RESULTS Between January and June 2015, a total of 200 women were enrolled. Fifteen percent were screen positive by VIA, 20% by DC, 47% by Xpert HPV, and 6% by OncoE6. Using a CIN 2+ threshold, the sensitivity and specificity of VIA were 48% (95% CI = 30%-67%) and 92% (95% CI = 86%-95%), respectively. Similarly, the sensitivity and specificity of DC were 59% (95% CI = 41%-76%) and 88% (95% CI = 82%-93%), respectively. The sensitivity and specificity of Xpert HPV were 88% (95% CI = 71%-97%) and 60% (95% CI = 52%-68%), respectively. Finally, the sensitivity and specificity of OncoE6 were 31% (95% CI = 16%-50%) and 99% (95% CI = 97%-100%), respectively. CONCLUSIONS VIA and DC displayed moderate sensitivity and high specificity. Xpert HPV performed equivalently to currently approved HPV DNA tests, with high sensitivity and moderate specificity. OncoE6 displayed excellent specificity but low sensitivity. These results confirm an important role for VIA, DC, and Xpert HPV in screen-and-treat cervical cancer prevention in low- and middle-income countries, such as Zambia.
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19
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Carlander C, Wagner P, Svedhem V, Elfgren K, Westling K, Sönnerborg A, Sparén P. Impact of immunosuppression and region of birth on risk of cervical intraepithelial neoplasia among migrants living with HIV in Sweden. Int J Cancer 2016; 139:1471-9. [PMID: 27177207 DOI: 10.1002/ijc.30188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 04/20/2016] [Accepted: 05/02/2016] [Indexed: 11/09/2022]
Abstract
Little is known about the incidence and risk of cervical intraepithelial neoplasia (CIN) grade 3, adenocarcinoma in situ and invasive cervical cancer (CIN3+) among migrants living with HIV in a European setting. We assessed the cumulative incidence (CuI) and hazard ratio (HR) of CIN2+ and CIN3+ in a cohort of women living with HIV (WLWH) (n = 893) identified from the Swedish national HIV register and HIV-negative women (n = 205,842) identified from the Swedish Population Register, matched on region of birth and age. Data was collected between 1993 and 2011 by linking our cohort with the Swedish National Cervical Screening Registry, collecting all cytological and histological results since 1993. The CuI of CIN3+ was 13.1% [95% confidence interval (CI) 8.9-17.2] for WLWH and 2.1% (95% CI 2.0-2.2) for HIV-negative after 18 years of follow-up. WLWH had more than eight times higher, age and region of birth matched, risk of CIN3+ than HIV-negative (HR 8.8: 95% CI 6.9-11.3). WLWH born in the East region, dominated by Thai women, had a two times higher risk of CIN3+ compared with WLWH born in Sweden (HR 2.47: 95% CI 1.2-5.0), which remained after adjusting for immunosuppression. Our results showed a substantially increased risk of CIN3+ among WLWH, which differed depending on birth region. Early HIV diagnosis and attendance to cervical cancer screening, with focus on migrants, is of crucial importance to minimize the incidence of cervical intraepithelial neoplasia.
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Affiliation(s)
- Christina Carlander
- Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research, County Hospital Västerås, Västerås, Sweden
| | - Philippe Wagner
- Centre for Clinical Research, County Hospital Västerås, Västerås, Sweden
| | - Veronica Svedhem
- Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Elfgren
- CLINTEC, Department of Obstetrics and Gynaecology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Katarina Westling
- Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Anders Sönnerborg
- Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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20
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Campbell C, Kafwafwa S, Brown H, Walker G, Madetsa B, Deeny M, Kabota B, Morton D, Ter Haar R, Grant L, Cubie HA. Use of thermo-coagulation as an alternative treatment modality in a 'screen-and-treat' programme of cervical screening in rural Malawi. Int J Cancer 2016; 139:908-15. [PMID: 27006131 PMCID: PMC5084797 DOI: 10.1002/ijc.30101] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/01/2016] [Accepted: 02/19/2016] [Indexed: 12/22/2022]
Abstract
The incidence of cervical cancer in Malawi is the highest in the world and projected to increase in the absence of interventions. Although government policy supports screening using visual inspection with acetic acid (VIA), screening provision is limited due to lack of infrastructure, trained personnel, and the cost and availability of gas for cryotherapy. Recently, thermo‐coagulation has been acknowledged as a safe and acceptable procedure suitable for low‐resource settings. We introduced thermo‐coagulation for treatment of VIA‐positive lesions as an alternative to cryotherapy within a cervical screening service based on VIA, coupled with appropriate, sustainable pathways of care for women with high‐grade lesions and cancers. Detailed planning was undertaken for VIA clinics, and approvals were obtained from the Ministry of Health, Regional and Village Chiefs. Educational resources were developed. Thermo‐coagulators were introduced into hospital and health centre settings, with theoretical and practical training in safe use and maintenance of equipment. A total of 7,088 previously unscreened women attended VIA clinics between October 2013 and March 2015. Screening clinics were held daily in the hospital and weekly in the health centres. Overall, VIA positivity was 6.1%. Almost 90% received same day treatment in the hospital setting, and 3‐ to 6‐month cure rates of more than 90% are observed. Thermo‐coagulation proved feasible and acceptable in this setting. Effective implementation requires comprehensive training and provider support, ongoing competency assessment, quality assurance and improvement audit. Thermo‐coagulation offers an effective alternative to cryotherapy and encouraged VIA screening of many more women. What's new? Malawi has the highest incidence rates for cervical cancer worldwide, and a “screen‐and‐treat” program is in place to identify and treat precancerous lesions. Conventional cryotherapy is challenging as gas supply is inconsistent, cylinders are difficult to transport and running costs are high. Here, the authors introduce thermo‐coagulation as a treatment alternative, which proved feasible and acceptable in this resource‐poor setting and could increase the number of women receiving timely treatment for precancerous lesions in low‐ and middle‐income countries.
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Affiliation(s)
- Christine Campbell
- Usher Institute for Population Health Sciences and Informatics, Teviot Place, University of Edinburgh, EH8 9AG, United Kingdom
| | | | - Hilary Brown
- Department of Obstetrics and Gynaecology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, United Kingdom
| | - Graeme Walker
- Department of Obstetrics and Gynaecology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, United Kingdom
| | | | - Miriam Deeny
- Department of Gynaecology, Stobhill Hospital, Glasgow, G21 3UW, United Kingdom
| | | | | | | | - Liz Grant
- Global Health Academy, University of Edinburgh, 1 George Square, Edinburgh, EH8 9JZ, United Kingdom
| | - Heather A Cubie
- Global Health Academy, University of Edinburgh, 1 George Square, Edinburgh, EH8 9JZ, United Kingdom
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Kelly H, Mayaud P, de Sanjose S. Concomitant Infection of HIV and HPV: What Are the Consequences? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-015-0132-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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