Targeting elimination of cervical cancer by 2030: a baseline assessment in six African countries-part II

Cervical cancer screening: a comparative study of TruScreen vs. Pap Smear

OBJECTIVES

This study aimed to evaluate the potential of real-time optoelectronic device (TruScreen™; TS; TruScreen Group Limited, New Zealand) as an alternative or adjunct to Pap Smear (Liquid Based Cytology (LBC)) for cervical cancer screening.

METHOD

We conducted a prospective observational pilot study involving 507 women who were routinely followed at gynecology clinics. All participants underwent TS and LBC examinations after study enrolment. Those with abnormal findings were referred for colposcopy and cervical biopsy within one month.

RESULTS

Overall, 507 women fulfilled the eligibility criteria and were included in this study, of which 30 women (5.9%) had abnormal TS findings and underwent colposcopy. Thirteen women (43.3%) had low-grade lesions, and only one (3.3%) had a high-grade lesion. Regarding biopsy findings, three women had cervical intraepithelial neoplasia (CIN) 1, two women had 'CIN2 + , and one had glandular hyperplasia. The TS yielded a sensitivity of 83.3% (95% CI: 35.9-99.6%) and a specificity of 95% (95% CI: 92.7- 96.8%) for the detection of cervical abnormality, compared to 66.7% (95% CI: 22.3-95.7%) and 98.2% (95%: CI 96.6%-99.2%) of the Pap smear, respectively. The difference between both screening tools was not statistically significant (p = 0.91). The sensitivity (100%, 95% CI 15.6-100%) and specificity (95.6%, 95% CI 93.4-97.2%) of TS and Pap smear for 'CIN2 + lesions were notably high.

CONCLUSION

TS demonstrated potential as a screening tool for cervical neoplasms in this preliminary study. The tool did not require cervical samples, laboratory equipment, or highly trained personnel. While our findings suggest the potential for real-time and accurate screening, further research with a larger sample size is necessary to confirm its reliability and practicality.

Access to brachytherapy treatment for cervical cancer management in Africa

Background and purpose

Cervical cancer is an important public health issue with a high incidence and death rate in Africa. It is mostly treated with Brachytherapy as the gold standard but its access is limited. This study set out to investigate the distribution and accessibility of brachytherapy units in Africa for the treatment of cervical cancer, and to provide some recommendations for increasing the quantity and accessibility of such equipment throughout the continent.

Materials and methods

The International Atomic Energy Agency's Division of Human Health's Directory for radiotherapy Centers (DIRAC) was the principal source of data for this study. The number of brachytherapy equipment in the 54 African countries was obtained from the DIRAC database. The number of cervical cancer cases was obtained from the GLOBOCAN 2022 database, and country's income was calculated using the Gross Domestic Product (GDP) per capita from the global economics database. All of these searches were conducted in February 2024.

Results

Africa exhibited a greater number of cervical cancer cases. A total of one hundred (100) brachytherapy units were present across 84 radiotherapy centres spanning 20 African countries. Egypt and South Africa each possess 23 units, which accounts for 46% of the overall quantity. With just two brachytherapy facilities, Nigeria had the most cervical cancer cases. A significant quantity of brachytherapy unit was situated in countries of northern Africa. The quantity of these units varied among countries, from those without any to those with many, and was not only influenced by GDP per capita.

Conclusion

Due to the rising incidence of cervical cancer in Africa, the number of brachytherapy equipment was woefully inadequate. Consequently, Africa requires partnerships and financial support to facilitate the quantity and accessibility of brachytherapy services. This will enable the provision of thorough and holistic care to patients and enhance their quality of life.

The World Health Organization targets for cervical cancer control by 2030: a baseline assessment in six African countries-part I

Aim

We present and analyse the findings of a survey of the readiness of the healthcare systems in Eswatini, Guinea, Malawi, Rwanda, Uganda and Zambia, to implement the necessary measures for attaining the targets for cervical cancer control, set by The World Health Organization (WHO), by the year 2030.

Methods

A questionnaire with 129 questions with preset answer options was completed in 2020, by ministries of health programme coordinators for non-communicable diseases, cancer control and/or reproductive health, and by WHO country offices, in the six countries selected.

Results

The findings on demographics, burden of disease, governance and management, laboratory services, equipment, supplies and medicines, as well as on personnel and training are presented here. The burden of cervical cancer in the countries studied is considerable, according to The International Agency for Research on Cancer estimations. The incidence of the disease is augmented by the high prevalence of HIV infection, in most of the countries surveyed. Most of the population live in rural areas, where access to the health services is far from ideal. Facilities for screening with human papilloma virus tests and for histopathology are limited. One pathologist covers the diagnostic needs of between 0.5 and 4 million inhabitants. Most other categories of health professionals are under-represented, and the capacity to train them is inadequate.

Conclusions

Strong country commitment and leadership, innovative solutions and extensive international cooperation would be needed to attain the targets of cervical cancer control set by WHO, in these countries.