Can visual cervical screening be sustained in routine health services? Experience from Mali, Africa.

OBJECTIVE

To assess the feasibility of sustaining visual cervical screening and treatment services in Mali, and to evaluate their performance and impact in improving the provision of cervical cancer control, following an initial cross-sectional study.

DESIGN

Descriptive study.

SETTING

Bamako area, Mali.

POPULATION

Women aged 30-59 years.

METHODS

Routine visual screening and treatment services were organised through two hospitals and 14 health centres. Patients with positive visual screening tests underwent colposcopy and/or directed biopsies, and ablative or surgical excision treatment was offered to those with cervical intraepithelial neoplasia (CIN).

MAIN OUTCOME MEASURES

Test positivity, detection and treatment rates for CIN and the sustainability of screening services.

RESULTS

Of the 14,141 women screened, 1682 (11.9%) were positive and were referred for further investigations and treatment. Over 75% of the screen-positive women underwent colposcopy and/or biopsy. CIN 1 was detected in 383 women, CIN 2 in 88, CIN 3 in 37 and invasive cervical cancer in 497. More than 80% of women with CIN and 35% of those with invasive cancer received treatment. The test performance characteristics and treatment coverage of routine screening were similar to those observed in the preceding cross-sectional study.

CONCLUSION

Visual screening and treatment services are sustainable and effective in improving cervical cancer control provision by health services in Bamako, Mali. It is essential to organise and sustain several point-of-care services in order to extend cervical cancer prevention in low-income African countries.