Implementing the 3T‐approach for cervical cancer screening in Cameroon: Preliminary results on program performance

Levy, Juliette; Preux, Marie de; Sormani, Jessica; Catarino, Rosa; Tincho, Eveline; Frund, Chloé; Fouogue, Jovanny Tsuala; Vassilakos, Pierre; Petignat, Patrick

doi:10.1002/cam4.3355

Cited by 23 publications

(38 citation statements)

References 22 publications

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“…The cases from Geneva were referred for colposcopy after positive cytology and HPV testing, whereas Cameroonian cases were women screened with HPV testing in a “test-triage-and-treat program”. All HPV-positive women received VIA for triage and biopsies, endocervical brushing (ECB), and cytology as a quality control measure [ 36 ].…”

Section: Methodsmentioning

confidence: 99%

“…It is our conviction that the different evolution of the color in the images of neoplastic and healthy tissue after application of acetic acid is a key element for detecting cervical precancer and cancer. Furthermore, the minimal training required for using our diagnosis system, and the increasing penetration rate of smartphones in LMICs, makes it ideal for countries with limited healthcare resources, where it can be easily integrated into a single-visit approach [ 36 ].…”

Section: Introductionmentioning

confidence: 99%

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Using Dynamic Features for Automatic Cervical Precancer Detection

et al. 2021

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Cervical cancer remains a major public health concern in developing countries due to financial and human resource constraints. Visual inspection with acetic acid (VIA) of the cervix was widely promoted and routinely used as a low-cost primary screening test in low- and middle-income countries. It can be performed by a variety of health workers and the result is immediate. VIA provides a transient whitening effect which appears and disappears differently in precancerous and cancerous lesions, as compared to benign conditions. Colposcopes are often used during VIA to magnify the view of the cervix and allow clinicians to visually assess it. However, this assessment is generally subjective and unreliable even for experienced clinicians. Computer-aided techniques may improve the accuracy of VIA diagnosis and be an important determinant in the promotion of cervical cancer screening. This work proposes a smartphone-based solution that automatically detects cervical precancer from the dynamic features extracted from videos taken during VIA. The proposed solution achieves a sensitivity and specificity of 0.9 and 0.87 respectively, and could be a solution for screening in countries that suffer from the lack of expensive tools such as colposcopes and well-trained clinicians.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Using Dynamic Features for Automatic Cervical Precancer Detection

et al. 2021

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“…This cross-sectional study is nested in a large prospective trial termed the '3T-study' (for 'Test-Triage-Treat' in a single visit) in Cameroon. 11 Our aim was to assess and compare the performance of commonly used triage tests such as visual inspection of the cervix and manual cytology for the detection of cervical intraepithelial neoplasia grade 2 or more severe (CIN2+) in HPV-positive women, individually and in combination with HPV-16/HPV-18/45 genotyping. Additionally, performance of automated cytology as a possible tool for triage was evaluated.…”

Section: Original Researchmentioning

confidence: 99%

“…The study design has already been published. 11 The data of the present study were retrieved between September 2018 and July 2019. Briefly, asymptomatic, non-pregnant women aged 30-49 years were eligible if they had no history of CIN treatment, no history of anogenital cancer, and no hysterectomy.…”

Section: Setting Screening Program and Study Designmentioning

confidence: 99%

“…12 13 Furthermore, we implemented an ABCD mnemonic method for visual assessment according to the following criteria: A for 'Acetowhiteness', B for 'Bleeding of a lesion in the transformation zone', C for 'Coloring confirmation with Lugol's iodine', and D for 'Diameter of the acetowhite area' (≥0.5 cm). 11 To be considered ABCD-positive, at least one of the following conditions needed to be fulfilled: presence of criteria A and D combined or criterion B (with or without presence of A, C or D). Decision to treat or not was based on VIA/ VILI and D-VIA/VILI combined diagnosis.…”

Section: Study Proceduresmentioning

confidence: 99%

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A cross-sectional study exploring triage of human papillomavirus (HPV)-positive women by visual assessment, manual and computer-interpreted cytology, and HPV-16/18–45 genotyping in Cameroon

Vassilakos

Wisniak

Catarino

et al. 2021

Int J Gynecol Cancer

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BackgroundHigh-risk human papillomavirus (HPV)-positive women require triage to identify those at higher risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). We aimed to compare visual assessment of the cervix, manual cytology and automated cytology as triage tests to screen HPV-positive women, and to assess over-treatment rates after visual assessment and over-referral rates to colposcopy after cytology.MethodsThe present cross-sectional study is nested in a large prospective screening trial in Cameroon. Evaluations of the tests have been conducted individually and in combination with HPV-16/HPV-18/45 genotyping. For the evaluation of over-treatment and colposcopic over-referral, we simulated two screening scenarios: (1) one-visit scenario (test-triage-and-treatment); and (2) two-visit scenario (test-triage-and-colposcopy).Results1582 women with a median age of 40 years (IQR 35–45) performed self-sampling for HPV testing, of which 294 (18.6%) were HPV-positive, and 12.2% had CIN2+. Sensitivities for CIN2+ detection were 77.1% for visual assessment, 80.0% for manual cytology, and 84.8% for automated cytology. Sensitivity of combined tests was higher compared with single tests. The highest sensitivity was obtained by the combination of genotyping and automated cytology (91.2%). In the one-visit scenario, the over-treatment rate was 83.9% in referred women, with a ratio of 6.2 treated women per CIN2+. In the two-visit scenario, the lowest over-referral rate would have been under manual cytology (45.0%), with a ratio of 1.8 referred women per CIN2+. Single and combined triage strategies by automated cytology gave rise to over-referral rates of 69.2% and 76.7%, respectively, and a ratio of 3.2 and 4.3 referred women per CIN2+, respectively.DiscussionTriage of HPV-positive women using a combination of genotyping and automated cytology for CIN2+ detection may provide public benefits in low- and middle-income countries.

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Self-supervised learning-based cervical cytology for the triage of HPV-positive women in resource-limited settings and low-data regime

Stegmüller,

Abbet,

Bozorgtabar

et al. 2024

Computers in Biology and Medicine

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Implementing the 3T‐approach for cervical cancer screening in Cameroon: Preliminary results on program performance

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 23 publications

References 22 publications

Using Dynamic Features for Automatic Cervical Precancer Detection

Using Dynamic Features for Automatic Cervical Precancer Detection

A cross-sectional study exploring triage of human papillomavirus (HPV)-positive women by visual assessment, manual and computer-interpreted cytology, and HPV-16/18–45 genotyping in Cameroon

Self-supervised learning-based cervical cytology for the triage of HPV-positive women in resource-limited settings and low-data regime

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