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

Abstract

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.

Efficacy of thermoablation in treating cervical precancerous lesions in a low-resource setting

“…Patients evaluated 4 weeks after treatment reported only minor adverse events such as vaginal discharge and low pain scores. 19 In a recent review, 8 , 20 other adverse effects, including vaginal bleeding, fainting, cervical stenosis, and local cervical infection, were reported, though rarely (<1%). The most frequent adverse effect was pain attributable to uterine cramps; this did not appear to prevent therapy or limit adherence to the study protocol.…”

Treatment of cervical intraepithelial lesions

“…were eligible for this treatment, and 99% received their treatment 1 month after screening. 26 Nearly all treated women reported vaginal discharge for up to 1 month after thermal coagulation and three women required antibiotics for vaginal infections, but there were no hospitalizations.…”

“…A study in Cameroon aimed to determine the percentage of screen‐positive patients who met the criteria to undergo thermal coagulation, but did not evaluate cure rate. Among 121 screen‐positive women, 91% were eligible for this treatment, and 99% received their treatment 1 month after screening . Nearly all treated women reported vaginal discharge for up to 1 month after thermal coagulation and three women required antibiotics for vaginal infections, but there were no hospitalizations.…”

“…Few reports of adverse events 16 Few reports of adverse events 17,25,27 ; reports of only minor adverse effects 26 No requirement for anesthesia No requirement for anesthesia (studies of patient experience are ongoing) lesions, but most cases treated with ablation were CIN 1, and LEEP was offered to most women with high-grade lesions. The authors reported that 95% of patients treated with either LEEP or thermal coagulation cleared the virus and were without evidence of CIN during follow-up.…”

Lamprey Prohibitin2 Arrest G2/M Phase Transition of HeLa Cells through Down-regulating Expression and Phosphorylation Level of Cell Cycle Proteins

“…Recently reports have suggested that cervical cancer (CC) represents one of the most common cancers among women worldwide 1 , 2 , accounting for over 500,000 new cases and 26000 cases of death annually 3 , 4 . Uncontrolled cell proliferation is an characteristic of tumor cells.…”