title: Feasibility of thermocoagulation in a screen-and-treat approach for the treatment of cervical precancerous lesions in sub-Saharan Africa.
abstract: The use of thermocoagulation for the treatment of cervical precancerous lesions has recently generated a great deal of interest. Our aim was to determine the feasibility of this outpatient procedure in the context of a cervical cancer (CC) screen-and-treat campaign in sub-Saharan Africa.
  
  
  
  Between July and December 2015, women living in the area of Dschang (Cameroon) aged between 30 and 49 years, were enrolled in a CC screening study. HPV self-sampling was performed as a primary screening test and women who were either "HPV 16/18/45-positive" or "positive to other HPV types and to VIA" were considered screen-positive, thus requiring further management. The primary outcome was the percentage of screen-positive patients who met the criteria to undergo thermocoagulation. The secondary outcome was the assessment of the procedure's side effects immediately after treatment and at the 1-month follow-up visit.
  
  
  
  A total of 1012 women were recruited in the study period. Among 121 screen-positive women, 110 of them (90.9%) were eligible to be treated with thermocoagulation. No patients discontinued treatment because of pain or other side effects. The mean ± SD (Standard Deviation) score measured on the 10-point Visual Analogue Scale (VAS) was 3.0 ± 1.6. Women having less than 2 children were more likely to report a higher pain score than those with more than two (4.2 ± 2.0 versus 2.9 ± 1.5, respectively; p value = 0.016). A total of 109/110 (99.1%) patients came to the 1-month follow-up visit. Vaginal discharge was reported in 108/109 (99.1%) patients throughout the month following treatment. Three patients (2.8%) developed vaginal infection requiring local antibiotics. No hospitalizations were required.
  
  
  
  The majority of screen-positive women met the criteria and could be treated by thermocoagulation. The procedure was associated to minor side effects and is overall feasible in the context of a CC screen-and-treat campaign in sub-Saharan Africa.
  
  
  
  The trial was retrospectively registered on November 11, 2015 with the identifier: ISRCTN99459678 .
authors.affiliation: Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland. manuela.viviano@gmail.com.|Division of Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, 1205, Geneva, Switzerland. manuela.viviano@gmail.com.
authors.forename: Manuela
authors.identifier: 0000-0001-7864-6731
authors.initials: M
authors.lastname: Viviano
authors.affiliation: Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon.
authors.forename: Bruno
authors.initials: B
authors.lastname: Kenfack
authors.affiliation: Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Rosa
authors.initials: R
authors.lastname: Catarino
authors.affiliation: Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon.
authors.forename: Eveline
authors.initials: E
authors.lastname: Tincho
authors.affiliation: Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon.
authors.forename: Liliane
authors.initials: L
authors.lastname: Temogne
authors.affiliation: Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.|Saint Damien Medical Centre, Ambanja, Madagascar.
authors.forename: Anne-Caroline
authors.initials: AC
authors.lastname: Benski
authors.affiliation: Department of Gynecology and Obstetrics, University Centre Hospital, Yaoundé, Cameroon.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Tebeu
authors.affiliation: Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Meyer-Hamme
authors.affiliation: Geneva Foundation for Medical Education and Research, Geneva, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Vassilakos
authors.affiliation: Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Petignat
mesh_terms: D000328:Adult; D002163:Cameroon; D055088:Early Detection of Cancer / Q000379:methods; D004564:Electrocoagulation / Q000592:standards*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D010147:Pain Measurement / Q000295:instrumentation / Q000379:methods; D027383:Papillomaviridae / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000628:therapy*; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000628:therapy; D014626:Vaginal Smears / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000628:therapy
keywords: Cervical cancer; Cervical intra-epithelial neoplasia (CIN); Human papillomavirus (HPV); Screen-and-treat; Thermocoagulation