Institut de la Francophonie pour la Médecine Tropicale (IFMT), Vientiane, Lao PDR.
BMC Cancer. 2014 Mar 6;14:161. doi: 10.1186/1471-2407-14-161.
Cervical cancer is the first female cancer in Lao PDR, a low-income country with no national screening and prevention programs for this human papillomavirus (HPV) associated pathology. HIV-infected women have a higher risk of persistent oncogenic HPV infection.The purpose of this study was to determine the knowledge, awareness and attitudes about cervical cancer among Lao women attending or not an HIV treatment center, in order to understand if this attendance had offered an opportunity for information and prevention.
A cross-sectional case-control survey was conducted in three provinces of Lao PDR, Vientiane, Luang Prabang and Savannakhet. Cases were 320 women aged 25 to 65, living with HIV and followed in an HIV treatment center. Controls were 320 women matched for age and place of residence, not attending an HIV treatment center.
Cases had a greater number of sexual partners and used condoms more often than controls. Only 36.6% of women had consulted a gynecologist (47.5% among cases and 25.6% among controls, p < 0.001) and 3.9% had benefited from at least one Pap smear screening (5.6% cases and 2.2% controls, p = 0.02). The average knowledge score was 3.5 on a 0 to 13 scale, significantly higher in cases than in controls (p < 0.0001). Despite having a lower education level and economic status, the women living with HIV had a better knowledge about cervical cancer and were more aware than the controls of the risk of developing such a cancer (35.9% vs. 8.4%, p = 0.0001). The main source of information was healthcare professionals. The main reasons for not undergoing Pap smear were the absence of symptoms and the default of medical injunction for cases, the lack of information and ignorance of screening usefulness for controls.
In Lao PDR, routine consultation in HIV treatment centers is not enough harnessed to inform women of their high risk of developing cervical cancer, and to perform screening testing and treatment of precancerous lesions. Implementing this cost-effective strategy could be the first step toward a national prevention program for cervical cancer.
宫颈癌是老挝的头号女性癌症，作为一个低收入国家，没有全国性的筛查和预防人乳头瘤病毒（HPV）相关疾病的计划。感染艾滋病毒的女性持续感染致癌 HPV 的风险更高。本研究的目的是确定参加或不参加艾滋病毒治疗中心的老挝妇女对宫颈癌的知识、意识和态度，以了解这种参与是否提供了信息和预防的机会。
在老挝的万象、琅勃拉邦和沙拉湾三个省进行了一项横断面病例对照调查。病例为 320 名年龄在 25 至 65 岁之间、患有艾滋病毒并在艾滋病毒治疗中心接受治疗的妇女。对照组为 320 名年龄和居住地相匹配、不参加艾滋病毒治疗中心的妇女。
病例组的性伴侣数量较多，使用避孕套的频率也较高。只有 36.6%的妇女曾咨询过妇科医生（病例组中 47.5%，对照组中 25.6%，p<0.001），只有 3.9%的妇女接受过至少一次巴氏涂片筛查（病例组中 5.6%，对照组中 2.2%，p=0.02）。0 至 13 分的平均知识评分，病例组显著高于对照组（p<0.0001）。尽管教育程度和经济地位较低，但感染艾滋病毒的妇女对宫颈癌的认识更好，比对照组更了解自己患此类癌症的风险（35.9%对 8.4%，p=0.0001）。信息的主要来源是医疗保健专业人员。不进行巴氏涂片检查的主要原因是病例组无症状和未遵医嘱，对照组则是缺乏信息和对筛查有用性的无知。
在老挝，艾滋病毒治疗中心的常规就诊并不能充分告知妇女其罹患宫颈癌的高风险，并进行筛查检测和癌前病变治疗。实施这一具有成本效益的策略可能是制定全国宫颈癌预防计划的第一步。
