Cervical cancer screening in a low‐resource setting: a pilot study on an HPV‐based screen‐and‐treat approach

• Published in: Cancer medicine (Malden, MA) MA), 2017-07, Vol.6 (7), p.1752-1761
• Main Authors: Kunckler, Margot, Schumacher, Fanny, Kenfack, Bruno, Catarino, Rosa, Viviano, Manuela, Tincho, Eveline, Tebeu, Pierre‐Marie, Temogne, Liliane, Vassilakos, Pierre, Petignat, Patrick
• Format: Article
• Language: English
• Subjects: Acetic acid; Adult; Africa South of the Sahara - epidemiology; Cancer Prevention; Cancer screening; Cervical cancer; Cervix; Early Detection of Cancer; Female; Genotypes; Health Resources; HPV; HPV testing; Human papillomavirus; Humans; Lugol's iodine; Mass Screening; Medical screening; Middle Aged; Original Research; Papillomaviridae; Papillomavirus Infections - complications; Papillomavirus Infections - diagnosis; Papillomavirus Infections - virology; Pilot Projects; Population studies; Risk Factors; screen‐and‐treat; self‐sampling; Socioeconomic Factors; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - etiology
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.1089

Cervical cancer (CC) is the leading cause of cancer‐related death among women in sub‐Saharan Africa, primarily because of limited access to effective screening and preventive treatment. Our aim was to assess the feasibility of a human papillomavirus (HPV)‐based CC screen‐and‐treat approach in a low‐resource context. We recruited 1012 women aged 30–49 years through a CC screening campaign conducted in the District Hospital of Dschang, Cameroon. Participants performed HPV self‐sampling, which was tested for high‐risk HPV (HR‐HPV) DNA using the point‐of‐care Xpert HPV assay. All HPV‐positive women were invited for visual inspection with acetic acid and Lugol's iodine (VIA/VILI) to exclude CC or enable triage. A cervical sample for histological analysis was also collected. Women positive for HPV 16/18/45 and for other HR‐HPV with pathological VIA/VILI were selected to undergo treatment with thermocoagulation. The HPV prevalence in the study population was 18.5% (n = 187); of these cases, 20 (10.6%), 42 (22.3%) and 140 (74.9%) were positive for HPV16, HPV18/45 and other HR‐HPV types, respectively. Overall, 107/185 (57.8%) VIA/VILI examinations were classified as pathological and 78 (42.2%) as normal. Women positive for HPV16/18/45 were 4.2 times more likely to harbor cervical intraepithelial neoplasia grade 2 or worse (CIN2+) than those with other HPV types. The specificity of HPV 16/18/45 genotypes for detection of high‐grade lesions among HR‐HPV positive women was higher than that of VIA/VILI in all age groups. The sensitivity and specificity of VIA/VILI in detecting CIN2+ among HPV positive women were 80% and 44%, respectively. Overall, 110/121 screen‐positive women (90.9%) were eligible for, and were treated with, thermocoagulation. An HPV‐based screen‐and‐treat approach is feasible in a low‐resource context and may contribute to improving the effectiveness of CC prevention programs. Immediate thermocoagulation treatment for women who are HPV16‐ and/or HPV18/45‐positive is a practical approach for the treatment of CIN2+. The combination of HPV‐testing and VIA/VILI for CC screening might reduce overtreatment. This study assesses the feasibility of a cervical cancer (CC) screen‐and‐treat 1‐day approach including vaginal self‐sampling and point‐of‐care HPV testing in a developing country. This approach may contribute to improving the effectiveness of CC prevention programs and decrease CC mortality in low‐resource countries.