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


METHODS
We 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).


RESULTS
Of 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.


CONCLUSIONS
High 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.
Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, United States of America.
Geneva A
GA
DeGregorio
Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, United States of America.
Leslie S
LS
Bradford
Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon.
Simon
S
Manga
Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon.
Pius M
PM
Tih
Department of African American Studies, Northeastern University, Boston, MA, United States of America.
Richard
R
Wamai
Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, United States of America.
Rebecca
R
Ogembo
Yaoundé Gyneco-Obstetrics and Pediatric Hospital, Yaoundé, Centre Region, Cameroon.
Zacharie
Z
Sando
Department of Pathology, University of Massachusetts Medical School, Worcester, MA, United States of America.
Yuxin
Y
Liu
School of Nursing, University of Massachusetts Amherst, Amherst, MA, United States of America.
Constance
C
Schwaiger
Department of Surgery, Boston University School of Medicine, Boston, MA, United States of America.
Sowmya R
SR
Rao
School of Nursing, University of Massachusetts Amherst, Amherst, MA, United States of America.
Karen
K
Kalmakis
Department of Nursing, University of Massachusetts Boston, Boston, MA, United States of America.
Lisa
L
Kennedy Sheldon
Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon.
Kathleen
K
Nulah
Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon.
Edith
E
Welty
Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon.
Thomas
T
Welty
Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America.
Javier Gordon
JG
Ogembo
D000328:Adult; D002163:Cameroon / Q000453:epidemiology; D005260:Female; D006801:Humans; D008403:Mass Screening; D009313:National Health Programs; D015995:Prevalence; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000517:prevention & control*