Characteristics and geographic distribution of HIV-positive women diagnosed with cervical cancer in Dar es Salaam, Tanzania

Abstract

Summary Background Cervical cancer is the leading incident cancer and the main cause of cancer-related mortality among women in sub-Saharan Africa. Furthermore, HIV-infected women are at a higher risk of developing cervical cancer than are HIV-negative women. The purpose of this study was to distinguish differences in characteristics of HIV-positive and HIV-negative patients with cervical cancer in Dar es Salaam, Tanzania. Methods The HIV status of cervical cancer patients diagnosed and/or treated at Ocean Road Cancer Institute in Dar es Salaam, Tanzania, during the period 2007–2011 was abstracted from the medical records. Additional abstracted information included patient’s name, age, place of residence, occupation, education, marital status, age at marriage, gravidity, and screening clinic visit results. Ocean Road Cancer Institute patients came from two sources, the screening clinic followed by treatment clinic or the treatment clinic without prior screening. HIV-positive and HIV-negative patients were compared regarding the above-listed clinical and epidemiologic factors. Multivariable analysis was also performed to assess the risk factors associated with cervical cancer treatment without prior screening at Ocean Road Cancer Institute. Results HIV-positive cervical cancer patients tended to be younger, with higher education, and lower parity. Patients screened for cervical cancer prior to treatment were more likely to be HIV-positive (OR: 2.09, 95% CI: 1.36, 3.21), less likely to have higher disease stages (OR: 0.64, 95% CI: 0.43, 0.94), and less likely to reside outside of Dar es Salaam (OR: 0.44, 95% CI: 0.30, 0.65). Conclusions Screening for cervical cancer at Ocean Road Cancer Institute is utilised by more HIV-positive patients from Dar es Salaam. Future studies should focus on identifying the reasons for lower utilisation of screening by HIV-negative patients and patients from other distant rural regions in Tanzania.

Barriers and Facilitators to Cervical Cancer Screening, Diagnosis, Follow-Up Care and Treatment: Perspectives of Human Immunodeficiency Virus-Positive Women and Health Care Practitioners in Tanzania

“…Many women believed hygiene, certain foods, or birth control could cause cervical cancer, which is similar to other studies on perceptions regarding cervical cancer in Africa . This is despite evidence that HIV‐positive women presenting for cervical cancer screening in Tanzania tended to be more highly educated than HIV‐negative women who presented for screening . Most women had not gotten screened for cervical cancer and only presented for care after experiencing symptoms.…”

Cervical cancer in low and middle‑income countries (Review)

“…The acetic acid solution swabbed on the surface of the cervix (cervical epithelium) turns pre-cancerous lesions white (43). Following a positive diagnosis, the lesions are immediately treated by cryotherapy (41). Similarly to other low-income, developing countries, the rates of HPV infection are high in Tanzania; this has led to the Tanzanian Ministry of Health to initiate a school-based HPV vaccination program (44).…”

“…Other factors that contribute to the high incidence of cervical cancer in Tanzania include; resource allocation (in term of distribution of trained personnel, funds and equipment in urban and rural areas nationwide), lack of resources to fulfil the needs of the entire population, sociocultural influence and a lack of political will (where leaders do not prioritise healthcare programmes and choose to divert funds and resources from screening and treatment programmes) (45). Sociocultural factors such as folklore and myths around cervical cancer screening influence the willingness of people to undergo screening (41).…”

Effects of HIV status on non-metastatic cervical cancer progression among patients in Lusaka, Zambia

“…This is a major public health challenge in Zambia, where the cervical cancer annual incidence rate is estimated to be between 33.7 and 58.4 per 100 000 with a mortality rate between 20.7 and 36.2 per 100,000 2–4. While the primary cause for cervical cancer is human papillomavirus (HPV), co-infection with HIV appears to increase the likelihood of progression to cancer 5. Women with HIV who are exposed to HPV are less likely to clear the virus and more likely to develop cervical cancer 6.…”