Evaluation of See-and-Treat Cervical Cancer Screening in Human Immunodeficiency Virus–Positive and Human Immunodeficiency Virus–Negative Women in Cameroon [332]. (May 2015) - DeGregorio, Geneva
Abstract : BACKGROUND: Invasive cervical cancer is the second leading cause of cancer mortality among women in Cameroon. To decrease the burden of invasive cervical cancer, the Cameroon Baptist Convention Health Services implemented the World Health Organization-endorsed "see-and-treat" cervical cancer screening program using visual inspection with acetic acid enhanced by digital cervicography. Our aim was determine the prevalence and predictors of a positive screen, rates of same-day treatment, and prevalence of cervical intraepithelial neoplasia (CIN) and invasive cervical cancer. METHODS: We completed a retrospective analysis of 33, 730 Cameroon Baptist Convention Health Services patients screened between 2007 and 2013. RESULTS: Of the 33, 660 cases with valid visual inspection with acetic acid data, 9.5% of women screened visual inspection with acetic acid-positive, 62.7% were visual inspection with acetic acid-negative, and 27.8% were considered "uncertain" as a result of poor visualization of the cervix or concurrent cervicitis. After covariate adjustment in a multivariable logistic regression model, human immunodeficiency virus (HIV)–positive women were 1.33 times more likely to screen visual inspection with acetic acid-positive than HIV-negative women (95% confidence interval 1.16–1.54, P <.001). Other factors associated with visual inspection with acetic acid-positive screens were rural screening location, gravidity, age at sexual debut, and number of lifetime sexual partners. Among women eligible for same-day cryotherapy, only 43% accepted the treatment. Pathology specimens (n=750) collected from women with visual inspection with acetic acid-positive lesions ineligible for cryotherapy identified 30% of cases as invasive cervical cancer and 70% as CIN. CONCLUSION: Risk factors for a positive screen included HIV positivity, rural location, and sexual behavior. Less than half of eligible patients opted for same-day treatment. Further studies are required to better identify barriers to implementing same-day treatment protocols.