title: Is screen-and-treat approach suited for screening and management of precancerous cervical lesions in Sub-Saharan Africa?
abstract: The World Health Organization guidelines for screening and management of cervical precancerous lesions updated in 2013 made an emphasis on the use of the 'screen-and-treat' approach for cervical cancer prevention. In order to facilitate scaling-up in low income settings, most of these screen-and-treat strategies do not involve confirmatory biopsy. This yields a certain rate of overtreatment. In other words, a majority of people undergoing screen-and-treat intervention who are treated does not necessarily benefit from the treatment. Therefore, the issue of potential short term and long term complications of the recommended treatment procedures (cryotherapy and Loop Electrosurgical Excision Procedure) arises. This question has seldom been studied in resource poor countries, particularly in Sub-Saharan Africa where Human Immunodeficiency Virus infection is rampant in an epidemic fashion and where the procreative capacities are socially rewarding for women. We draw the attention of the scientific community and policy makers to the fact that the lack of evidence supporting the safety of these treatment procedures in African populations may have an impact on the acceptability of these strategies and therefore on the effectiveness of screening programs.
authors.affiliation: Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland; Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Cameroon. Electronic address: fokom.domgue@gmail.com.
authors.forename: Joël
authors.initials: J
authors.lastname: Fokom-Domgue
authors.affiliation: Geneva Foundation for Medical Education and Research, Geneva, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Vassilakos
authors.affiliation: Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Petignat
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D017679:Cryotherapy / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D004598:Electrosurgery / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D027383:Papillomaviridae / Q000276:immunology / Q000472:pathogenicity; D053918:Papillomavirus Vaccines / Q000008:administration & dosage; D011230:Precancerous Conditions / Q000175:diagnosis / Q000628:therapy* / Q000821:virology; D019564:Unnecessary Procedures / Q000009:adverse effects / Q000639:trends; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical cancer; Cryotherapy; LEEP; Management; Prevention; Safety; Screen-and-treat; Sub-Saharan Africa