TITLE:
The Use of Visual Tests in the Screening Strategy of Cervical Dysplasies and Cervical Cancer at the Laquintinie Hospital Douala, Cameroon: A Cross-Sectional Study
AUTHORS:
Essome Henri, Mve Koh Valère, Egbe Obinchemti Thomas, Engbang Jean Paul, Essiben Felix, Boten Merlin, Tocki Toutou Grâce, Tsetsafong Aristophane, Mboudou Emile Telesphore
KEYWORDS:
IVA, IVL, Cervical Cancer, Sensitivity, Specificity
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.9 No.7,
July
26,
2019
ABSTRACT: Introduction: The prevalence of cervical cancer in Cameroon
is 80.73/100,000 women, with an estimated
incidence of 40/100,000 women-years. It is a real public health problem.
There is no systematic and effective screening program for cervical cancer in
our country, despite the advent of visual tests that are simple to use, low
cost, and adapted to the modest income of our social groups. Objectives: We aimed at determining the usefulness and place of
visual tests in screening for cervical dysplasia and cervical cancer for its implementation
at the Laquintinie Hospital Douala, Cameroon. Methods: We conducted a prospective analytic cross-sectional
study of cervical dysplasia and cervical cancer screening by visual testing at
the Laquintinie Hospital Douala from December 1, 2016 to March 31, 2017. Data
collection was by consecutive non-probabilistic method and consenting sexually
active women older than 21 years were enrolled for study. Data analysis was
with Epi InfoTM version 7. Associations were done with the Chi
square, student t-test and Fischer’s exact test where appropriate. Bivariate
and multivariate analysis was done and reported as odd ratios, adjusted odd
ratios and 95% confidence intervals. Statistical significance was set at P 0.05. Results: We received 1590 women, of
whom 1506 (94.7%) screened for dysplastic lesions and cervical cancer during
the study period. The results obtained were: 1417 (94.1%) had a normal result;
64 (4.2%) had a positive visual test (TV+); and 25 (1.7%) visual tests were
inconclusive (TV-nC). Of the 64 women whose visual tests were positive, 15
(23.5%) were HIV+. We performed 80 colposcopies and biopsies, including 61
women with positive visual tests and 19 non-conclusive visual tests. Among
women with TV+, we found 06 cancers (squamous cell carcinoma: 05,
adenocarcinoma: 01) and 05 dysplasias (CIN1: 04, CIN3: 01). Histological examination
in women with TV-nC revealed 02 dysplasias (CIN1: 02). Half of the women with
cervical cancer were HIV+. In our series, the prevalence of cervical dysplasia
and cervical cancer was respectively 05 per 1000 women and 04 per 1000 women.
The early onsets of sexual intercourse and co-infection with HIV
were the main factors associated. Visual tests were very sensitive (84.62%),
but with a relatively low specificity (25.37%). Conclusion: Visual tests prove to be a useful tool for mass
screening of precancerous and cancerous lesions of the cervix in view of its
sensitivity, cost and performance.