Cervical cancer screening and treatment of&amp;nbsp;cervical intraepithelial neoplasia in female sex workers using &amp;ldquo;screen and treat&amp;rdquo; approach

Joshi, Smita; Kulkarni, Vinay; Darak, Trupti; Mahajan, Uma; Srivastava, Yogesh; Gupta, Sanjay; Krishnan, Sumitra; Mandolkar, Mahesh; Bharti, Alok C.

doi:10.2147/ijwh.s80624

Cited by 23 publications

(32 citation statements)

References 24 publications

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“…Like in other studies [11,13,16], we observed minimal side-effects and complications which were not life-threatening, reflecting that thermal coagulation is well accepted and safe. Being highly safe, acceptable and efficacious makes thermal coagulation a suitable alternative to cryotherapy in the treatment of ectocervical CIN lesions, especially in low-resource settings.…”

Section: Nessa Et Al J Clin Gynecol Obstet 2017;6(3-4):58-64supporting

confidence: 85%

Efficacy, Safety, and Acceptability of Thermal Coagulation to Treat Cervical Intraepithelial Neoplasia: Pooled Data From Bangladesh, Brazil and India

Nessa¹,

Naud²,

Esmy³

et al. 2017

J Clin Gynecol Obstet

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Background: Treatment of cervical intraepithelial neoplasia (CIN) using thermal coagulation has recently attracted interest among the medical community in view of the easily portable and light equipment, less treatment time, faster patient turnover, less discomfort, use of minimal amounts of electricity as consumable, less vaginal discharge following treatment and a similar efficacy in treatment of ectocervical CIN lesions as compared to cryotherapy. However, literature on its performance is scarce particularly from low-and middle-income settings. Here, we report the effectiveness, safety and acceptability of thermal coagulation in women treated for histologically proven ectocervical CIN.

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Section: Nessa Et Al J Clin Gynecol Obstet 2017;6(3-4):58-64supporting

confidence: 85%

Efficacy, Safety, and Acceptability of Thermal Coagulation to Treat Cervical Intraepithelial Neoplasia: Pooled Data From Bangladesh, Brazil and India

Nessa¹,

Naud²,

Esmy³

et al. 2017

J Clin Gynecol Obstet

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“…No patients in our study discontinued treatment because of pain or other adverse effects, thus demonstrating that thermocoagulation is a low-pain procedure that can be successfully carried out until the end if patients are correctly informed and sufficiently cooperative [15]. Women generally expressed minimal discomfort, and those who experienced pain described it essentially as lower abdominal cramping, which was felt mainly during the procedure and immediately after it.…”

Section: Discussionmentioning

confidence: 82%

Feasibility of thermocoagulation in a screen-and-treat approach for the treatment of cervical precancerous lesions in sub-Saharan Africa

et al. 2017

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BackgroundThe 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.MethodsBetween 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.ResultsA 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.ConclusionThe 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.Trial registrationThe trial was retrospectively registered on November 11, 2015 with the identifier: ISRCTN99459678.

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“…Applications are repeated on all areas of the cervix which need treatment. No local anaesthetic is offered, consistent with the approach taken in other LMIC settings . Thermo‐coagulation is not provided if there is any evidence of glandular neoplasia or cervical cancer or if the woman is pregnant.…”

Section: Methodsmentioning

confidence: 99%

“…However, few of the included studies were from low‐income settings. Recent studies from India are beginning to provide such evidence . Preliminary findings indicated that use of thermo‐coagulation for treatment of lesions suggestive of CIN among HIV‐infected women in India was well tolerated without anaesthesia and was safe for delivery in out‐patient settings, with 6‐month cure rates of more than 80% .…”

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confidence: 99%

Use of thermo‐coagulation as an alternative treatment modality in a ‘screen‐and‐treat’ programme of cervical screening in rural Malawi

Campbell

Kafwafwa

Brown

et al. 2016

Intl Journal of Cancer

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The incidence of cervical cancer in Malawi is the highest in the world and projected to increase in the absence of interventions. Although government policy supports screening using visual inspection with acetic acid (VIA), screening provision is limited due to lack of infrastructure, trained personnel, and the cost and availability of gas for cryotherapy. Recently, thermo‐coagulation has been acknowledged as a safe and acceptable procedure suitable for low‐resource settings. We introduced thermo‐coagulation for treatment of VIA‐positive lesions as an alternative to cryotherapy within a cervical screening service based on VIA, coupled with appropriate, sustainable pathways of care for women with high‐grade lesions and cancers. Detailed planning was undertaken for VIA clinics, and approvals were obtained from the Ministry of Health, Regional and Village Chiefs. Educational resources were developed. Thermo‐coagulators were introduced into hospital and health centre settings, with theoretical and practical training in safe use and maintenance of equipment. A total of 7,088 previously unscreened women attended VIA clinics between October 2013 and March 2015. Screening clinics were held daily in the hospital and weekly in the health centres. Overall, VIA positivity was 6.1%. Almost 90% received same day treatment in the hospital setting, and 3‐ to 6‐month cure rates of more than 90% are observed. Thermo‐coagulation proved feasible and acceptable in this setting. Effective implementation requires comprehensive training and provider support, ongoing competency assessment, quality assurance and improvement audit. Thermo‐coagulation offers an effective alternative to cryotherapy and encouraged VIA screening of many more women.

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Cervical cancer screening and treatment of cervical intraepithelial neoplasia in female sex workers using “screen and treat” approach

Cited by 23 publications

References 24 publications

Efficacy, Safety, and Acceptability of Thermal Coagulation to Treat Cervical Intraepithelial Neoplasia: Pooled Data From Bangladesh, Brazil and India

Efficacy, Safety, and Acceptability of Thermal Coagulation to Treat Cervical Intraepithelial Neoplasia: Pooled Data From Bangladesh, Brazil and India

Feasibility of thermocoagulation in a screen-and-treat approach for the treatment of cervical precancerous lesions in sub-Saharan Africa

Use of thermo‐coagulation as an alternative treatment modality in a ‘screen‐and‐treat’ programme of cervical screening in rural Malawi

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