Acceptability and Safety of Thermal Ablation to Prevent Cervical Cancer in Sub-Saharan Africa

Abstract

Background - The World Health Organization recommends thermal ablation as an alternative to cryotherapy to treat women with precancerous lesions in low-resource settings. However, limited data are available on women’s experience and adverse events (AEs) of the procedure in the context of Sub-Saharan Africa. The objective of this study was to evaluate the acceptability and safety of thermal ablation in women screened positive for precancerous cervical lesions.Methods - Asymptomatic women aged 30-49 years old living in the Dschang Health District were invited to participate in a cervical cancer screening campaign termed “3T-Approach" (for Test-Triage and Treat). Recruited women were asked to perform HPV self-sampling followed by triage with visual assessment and treatment with thermal ablation if required. After treatment and 4-6 weeks later, interviews were conducted to assess women’s experience on anxiety, discomfort, and pain during thermal ablation. AEs were recorded on pre-defined electronic forms 4-6 weeks after treatment to assess the procedure’s safety.Results - Between September 2018 and January 2020, 399 HPV-positive women (18.7% of women screened) were recruited, 236 (59.1%) had a positive visual assessment, 234 were treated by thermal ablation and 198 (84.6%) received therapy in the same visit. Treatment was not considered as painful (score ≤4/10) by 209 (90.9%) patients while 5 (2.5%) reported high pain (score 8-10/10). During post-treatment interviews 4-6 weeks later, most reported AEs were graded mild or moderate (grade I-II). The most frequent symptoms reported as mild AEs (grade 1-2) were vaginal watery discharge (75.5%), vaginal bloody-stained discharge (21.5%) and malodourous discharge (14.5%). None of the participants experienced serious AEs (grade 3-4) or AEs requiring admission to hospital or emergency consultation. The vast majority of women (99.6%) would agree to repeat the procedure if necessary and (99.6%) would recommend it to friends or family. Conclusion - Thermal ablation is widely accepted by women and appears as a safe procedure. It may contribute to improving the link between screening and treatment in a single visit and to optimizing cervical cancer control in low-resource settings.Trial registrations: The study was registered on clinicaltrials.gov (NCT03757299) in November 2018 (28/11/2018).

Experiences with thermal ablation for cervical precancer treatment after self‐collection HPV‐based screening in the ASPIRE Mayuge randomized trial

“…In the few studies available, the use of thermal ablation for the treatment of cervical lesions is generally feasible and acceptable, [14][15][16] yet there is some heterogeneity in the literature in the acceptability of thermal ablation across diverse settings. 15 Some recent studies have found initial evidence of minimal side effects of thermal ablation immediately after treatment, 17,18 but gaps remain in knowledge about the side effects and potential adverse events that occur throughout the recovery period of up to 6 to 8 weeks after treatment, and detailed data on the acceptability of the treatment and subsequent side effects are needed. With a global shift to HPV-based screening, appropriate management algorithms need to be implemented to minimize treatment related harms, 19 20,21 and pertinent details for this study are presented below.…”