title: Most women diagnosed with cervical cancer by a visual screening program in Tanzania completed treatment: evidence from a retrospective cohort study.
abstract: BACKGROUND
  Visual inspection with acetic acid (VIA) to identify and treat pre-cancerous lesions is effective for cervical cancer prevention. Screening programs also facilitate screening and diagnosis of invasive cancers that must be referred for radiation therapy or chemotherapy. This study compared characteristics of women diagnosed with invasive cervical cancer by a VIA screening program who did and did not follow up for treatment and who did and did not complete treatment at the Ocean Road Cancer Institute (ORCI), Dar es Salaam, Tanzania.
  
  
  METHODS
  We conducted a retrospective cohort study of ORCI screening referrals from the period November 2002 to June 2011. Women referred for treatment of invasive disease (n = 980) were identified from an existing database of all women attending the screening clinic during this period (n = 20,131) and matched to a dataset of all cervical cancer patients attending ORCI in this period (n = 8,240). Treatment information was abstracted from patient records of women who followed up. Records of a random sample (n = 333) of unscreened patients were reviewed for disease stage.
  
  
  RESULTS
  Of the 980 women referred women, 829 (84.6%) sought treatment. Most of those women (82.8%) completed their prescribed radiation. Lower disease stage, having a skilled occupation, residence in Dar es Salaam, and younger age were independently associated with loss to follow-up. Higher disease stage, residence in Dar es Salaam, older age, and later year of first treatment appointment were independently associated with incomplete treatment among those who followed up. Significantly more screened women had stage 1 disease (14.0%) than unscreened women (7.8%).
  
  
  CONCLUSIONS
  Most women referred from the screening clinic completed treatment for their cancer at ORCI. Some of those lost to follow-up may have sought treatment elsewhere. In most cases, the screening clinic appears to facilitate diagnosis and treatment, rather than screening, for women with invasive cervical cancer.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Gard
authors.affiliation: University of Nebraska Medical Center College of Public Health, Omaha, NE, USA. amr.soliman@unmc.edu.
authors.forename: Amr S
authors.initials: AS
authors.lastname: Soliman
authors.forename: Twalib
authors.initials: T
authors.lastname: Ngoma
authors.forename: Julius
authors.initials: J
authors.lastname: Mwaiselage
authors.forename: Crispin
authors.initials: C
authors.lastname: Kahesa
authors.forename: Robert M
authors.initials: RM
authors.lastname: Chamberlain
authors.forename: Siobán D
authors.initials: SD
authors.lastname: Harlow
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059012:Lost to Follow-Up; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013636:Tanzania / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control* / Q000532:radiotherapy