Prevalence, Predictors, and Same Day Treatment of Positive VIA Enhanced by Digital Cervicography and Histopathology Results in a Cervical Cancer Prevention Program in Cameroon

Abstract

BackgroundIn 2007, the Cameroon Baptist Convention Health Services (CBCHS) implemented a screen-and-treat cervical cancer prevention program using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC).MethodsWe retrospectively analyzed 46,048 medical records of women who received care through the CBCHS Women’s Health Program from 2007 through 2014 to determine the prevalence and predictors of positive VIA-DC, rates of same day treatment, and cohort prevalence of invasive cervical cancer (ICC).ResultsOf the 44,979 women who were screened for cervical cancer, 9.0% were VIA-DC-positive, 66.8% were VIA-DC-negative, 22.0% were VIA-DC-inadequate (normal ectocervix, but portions of the transformation zone were obscured), and 2.2% were VIA-DC-uncertain (cervical abnormalities confounding VIA-DC interpretation). Risk factors significantly associated with VIA-DC-positive screen were HIV-positivity, young age at sexual debut, higher lifetime number of sexual partners, low education status and higher gravidity. In 2014, 31.1% of women eligible for cryotherapy underwent same day treatment. Among the 32,788 women screened from 2007 through 2013, 201 cases of ICC were identified corresponding to a cohort prevalence of 613 per 100,000.ConclusionsHigh rate of VIA-DC-positive screens suggests a significant burden of potential cervical cancer cases and highlights the need for expansion of cervical cancer screening and prevention throughout the 10 regions of Cameroon. VIA-DC-inadequate rates were also high, especially in older women, and additional screening methods are needed to confirm whether these results are truly negative. In comparison to similar screening programs in sub-Saharan Africa there was low utilization of same day cryotherapy treatment. Further studies are required to characterize possible program specific barriers to treatment, for example cultural demands, health system challenges and cost of procedure. The prevalence of ICC among women who presented for screening was high and requires further investigation.

Implementing a Fee-for-Service Cervical Cancer Screening and Treatment Program in Cameroon: Challenges and Opportunities

“…WHP clinical data are collected on structured paper‐based forms at the point‐of‐care and then sent to the CBCHS Regional Training Center in Mutengene for entry into a centralized electronic database . In collaboration with data managers at CBCHS and the Department of Quantitative Health Sciences at the University of Massachusetts Medical School (UMMS), de‐identified electronic medical records from March 2007 to December 2014 were retrieved and securely transferred to UMMS for data coding and analysis.…”

Relationship Between Infertility and Digital Cervicography Findings in Cameroonian Women

“…A positive result was defined as the presence of acetowhite lesion on DC. Results of Lugol's iodine were not used in this study, because a prior study of the WHP patient population had shown no significant difference between findings of visual inspection with acetic acid and those with Lugol's iodine (15). Of note, positive findings on DC correlate with precancerous or cancerous cervical neoplasia findings on pathology.…”

Challenges with Cervical Cancer Treatment in Cameroon

“…The reason could be attributed to selection bias because a good number of women with symptoms suspicious of ICC self-referred themselves for screening. The majority of these ICC cases (61.1%) were in women over age 50 [9].…”

“…WHP runs the largest cervical cancer prevention program in Cameroon [9]. Between 2007 and 2014, the program screened 44,979 women for cervical cancer using the VIA-DC technique and the overall positive rate was 9.0% [9].…”

“…Between 2007 and 2014, the program screened 44,979 women for cervical cancer using the VIA-DC technique and the overall positive rate was 9.0% [9]. From 2007 through 2013, the prevalence of ICC in WHP was 613 per 100,000 women screened.…”