Comprehensive Cervical Cancer Prevention in Tanzania (CONCEPT) study: Cohort profile

Mchome, Bariki; Swai, Patricia; Wu, Chunsen; Katanga, Johnson; Kahesa, Crispin; Manongi, Rachel; Mwaiselage, Julius D; Kjaer, Susanne; Rasch, Vibeke; Linde, Ditte Søndergaard

doi:10.1136/bmjopen-2020-038531

Cited by 14 publications

(25 citation statements)

References 34 publications

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“…In Tanzania, very limited studies estimating the coverage of cervical cancer screening by age exist [ 12 ]. However, a follow-up study that enrolled women aged between 25 and 60 years from three cervical cancer screening clinics from urban and semi-rural areas in Tanzania reported 17.2% (696/4,043) and 14.2% (438/3,074) of the women aged between 25 and 60 years had high-risk HPV (hr-HPV) at baseline and in the first follow-up, respectively [ 13 ]. Only 3.4% (139/4,043) of the women aged between 25 and 60 years had high-grade squamous intraepithelial lesion (HSIL) in the same study [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, a follow-up study that enrolled women aged between 25 and 60 years from three cervical cancer screening clinics from urban and semi-rural areas in Tanzania reported 17.2% (696/4,043) and 14.2% (438/3,074) of the women aged between 25 and 60 years had high-risk HPV (hr-HPV) at baseline and in the first follow-up, respectively [ 13 ]. Only 3.4% (139/4,043) of the women aged between 25 and 60 years had high-grade squamous intraepithelial lesion (HSIL) in the same study [ 13 ]. Another study by Dartell et al [ 11 ] reported lower sensitivity of VIA than HPV-testing in detecting HSIL cervical lesions during a hospital-based cervical cancer screening event in Dar es Salaam, Tanzania.…”

Section: Introductionmentioning

confidence: 99%

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Expression analysis of p16 and TOP2A protein biomarkers in cervical cancer lesions and their correlation with clinico-histopathological characteristics in a referral hospital, Tanzania

et al. 2021

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Introduction Biomarkers yield important information for early diagnosis of cervical cancer. However, they are rarely applied for prognosis of cervical cancer in Tanzania, where visual inspection assay with acetic acid or Lugol’s iodine and Pap test are being used as the standard screening/ diagnostic methods. Methods This was a retrospective hospital-based cross-sectional study that was conducted to assess cyclin-dependent kinase inhibitor (p16) and topoisomerase II-alpha (TOP2A) proteins expression among women seeking cervical cancer care at Kilimanjaro Christian Medical Centre, Tanzania between May 1, 2017 and May 10, 2018. Immunohistochemistry technique was used to detect the expressions of p16 and TOP2A proteins from the retrieved formalin-fixed and paraffin-embedded (FFPE) cervical biopsies. Results A total of 145 patients, with a mean age of 52.1 ± 12.9 years, were included in this study. Upon immunohistochemistry staining, 103 (71.0%) and 90 (62.1%) were p16 and TOP2A positive respectively. There was a strong association between histopathological class and p16/TOP2A expression levels (Fisher’s exact test, p<0.001). Moreover, there was a strong positive correlation between p16/TOP2A and cancerous cervical lesions (Spearman’s rank correlation coefficients = 0.833 and 0.687, p = 0.006 and 0.005, respectively). The age-adjusted odds ratio for predicting cervical cancer lesions were independently significant for p16/TOP2A biomarkers in FFPE cervical tissues [p16: OR = 1.142 (95% CI: 1.059–1.232, p<0.001) and TOP2A: OR = 1.046 (95% CI: 1.008–1.085, p = 0.015)]. Importantly, the diagnostic performance of p16 was higher than that of TOP2A in the diagnosis of cancerous lesions from non-cancerous cervical lesions (sensitivity: 97.2% versus 77.6%, accuracy: 92.8% versus 87.8%, respectively). Conclusion Our study has highlighted that over-expression of TOP2A is related to the grade of cervical intraepithelial neoplasia but does not predict prognosis in cervical cancer. Similarly, expression of p16 is related to degree of histological dysplasia and malignancy, suggesting its prognostic and predictive value in the management of cervical cancers. Further bigger studies are needed to validate their applications in the early diagnosis of cervical cancer.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Expression analysis of p16 and TOP2A protein biomarkers in cervical cancer lesions and their correlation with clinico-histopathological characteristics in a referral hospital, Tanzania

et al. 2021

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“…2 To determine whether there are, in fact, different rates of clearance by population, it will be necessary to analyze prospective data from settings that are underrepresented in the literature. We and others are analyzing data from the African Collaborative Center for Microbiome and Genomics Research (ACCME) 41 and CONCEPT (Tanzania) 44 cohorts. HPV clearance rates that differ by geographical region would have implications for microsimulation models of HPV natural history used for costeffectiveness analysis, which to date rely on transition probabilities from populations with steadily declining age-specific HPV prevalence.…”

Section: Discussionmentioning

confidence: 99%

Different human papillomavirus types share early natural history transitions in immunocompetent women

Adebamowo

Befano

Cheung

et al. 2022

Intl Journal of Cancer

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Necessary stages of cervical carcinogenesis include acquisition of a carcinogenic human papillomavirus (HPV) type, persistence associated with the development of precancerous lesions, and invasion. Using prospective data from immunocompetent women in the Guanacaste HPV Natural History Study (NHS), the ASCUS‐LSIL Triage Study (ALTS) and the Costa Rica HPV Vaccine Trial (CVT), we compared the early natural history of HPV types to inform transition probabilities for health decision models. We excluded women with evidence of high‐grade cervical abnormalities at any point during follow‐up and restricted the analysis to incident infections in all women and prevalent infections in young women (aged <30 years). We used survival approaches accounting for interval‐censoring to estimate the time to clearance distribution for 20 529 HPV infections (64% were incident and 51% were carcinogenic). Time to clearance was similar across HPV types and risk classes (HPV16, HPV18/45, HPV31/33/35/52/58, HPV 39/51/56/59 and noncarcinogenic HPV types); and by age group (18‐29, 30‐44 and 45‐54 years), among carcinogenic and noncarcinogenic infections. Similar time to clearance across HPV types suggests that relative prevalence can predict relative incidence. We confirmed that there was a uniform linear association between incident and prevalent infections for all HPV types within each study cohort. In the absence of progression to precancer, we observed similar time to clearance for incident infections across HPV types and risk classes. A singular clearance function for incident HPV infections has important implications for the refinement of microsimulation models used to evaluate the cost‐effectiveness of novel prevention technologies.

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“…This study is part of the Comprehensive Cervical Cancer Prevention in Tanzania (CONCEPT) study. A detailed description of the cohort profile has been published elsewhere [ 11 ]. Data were collected between August 2015 and October 2018 at two cervical cancer screening clinics in the Kilimanjaro Region; Mawenzi Regional Hospital and Kilimanjaro Christian Medical Centre (KCMC), and one screening clinic in the Dar es Salaam Region; Ocean Road Cancer Institute (ORCI).…”

Section: Methodsmentioning

confidence: 99%

Persistence and risk factors of high-risk human papillomavirus infection among HIV positive and HIV negative tanzanian women: a cohort study

Swai

Rasch

Linde

et al. 2022

Infect Agents Cancer

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Background High-risk (HR) human papillomavirus (HPV) persistence is the most important risk factor for cervical cancer. We have assessed the type-specific HR HPV persistence among HIV positive and HIV negative Tanzanian women and factors associated with HR HPV persistence. Methods In a cohort study including 4080 Tanzanian women, 3074 attended follow-up examination (up to 32 months after enrollment). Cervical samples were obtained for liquid-based cytology and HPV DNA testing using Hybrid Capture 2 and Inno-Lipa Extra II. Information on lifestyle factors was collected through a personal interview. The probability of HR HPV persistence at a given time point since enrollment was estimated non-parametrically using the EMICM algorithm. Results Among the 462 women HR HPV positive at enrollment, 158 had at least one identical type detected at follow-up. The probability of persistence at 18 months after enrollment was 34.2 (95% CI 29.0–39.4). Stratifying by HIV status, the persistence probability was 42.9% (95% CI 33.5–51.9) among HIV positive, and 28.0% (95% CI 22.1–34.2) among HIV negative. Overall, HR HPV persistence was most common for HPV58, 35, 16, 31, and 52. Among HIV positive women it was HPV45, and HPV16, followed by HPV58 and HPV18, and among HIV negative women it was HPV31, HPV33 and HPV58. Risk factors associated with persistence of HR HPV were older age, longer interval between enrollment and follow-up, binge drinking, and HIV status. Conclusions HR HPV persistence was common in Tanzania, and most common among HIV positive women. Overall, persistence was most frequent for HPV 58, 35, 16, 31 and 52. The nonavalent HPV vaccine should be considered.

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Comprehensive Cervical Cancer Prevention in Tanzania (CONCEPT) study: Cohort profile

Cited by 14 publications

References 34 publications

Expression analysis of p16 and TOP2A protein biomarkers in cervical cancer lesions and their correlation with clinico-histopathological characteristics in a referral hospital, Tanzania

Expression analysis of p16 and TOP2A protein biomarkers in cervical cancer lesions and their correlation with clinico-histopathological characteristics in a referral hospital, Tanzania

Different human papillomavirus types share early natural history transitions in immunocompetent women

Persistence and risk factors of high-risk human papillomavirus infection among HIV positive and HIV negative tanzanian women: a cohort study

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