Kunckler Margot, Schumacher Fanny, Kenfack Bruno, Catarino Rosa, Viviano Manuela, Tincho Eveline, Tebeu Pierre-Marie, Temogne Liliane, Vassilakos Pierre, Petignat Patrick
Gynecology Division, Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland.
Department of Biomedical Sciences, University of Dschang, Dschang District Hospital, Dschang, Cameroon.
Cancer Med. 2017 Jul;6(7):1752-1761. doi: 10.1002/cam4.1089. Epub 2017 Jun 4.
Cervical cancer (CC) is the leading cause of cancer-related death among women in sub-Saharan Africa, primarily because of limited access to effective screening and preventive treatment. Our aim was to assess the feasibility of a human papillomavirus (HPV)-based CC screen-and-treat approach in a low-resource context. We recruited 1012 women aged 30-49 years through a CC screening campaign conducted in the District Hospital of Dschang, Cameroon. Participants performed HPV self-sampling, which was tested for high-risk HPV (HR-HPV) DNA using the point-of-care Xpert HPV assay. All HPV-positive women were invited for visual inspection with acetic acid and Lugol's iodine (VIA/VILI) to exclude CC or enable triage. A cervical sample for histological analysis was also collected. Women positive for HPV 16/18/45 and for other HR-HPV with pathological VIA/VILI were selected to undergo treatment with thermocoagulation. The HPV prevalence in the study population was 18.5% (n = 187); of these cases, 20 (10.6%), 42 (22.3%) and 140 (74.9%) were positive for HPV16, HPV18/45 and other HR-HPV types, respectively. Overall, 107/185 (57.8%) VIA/VILI examinations were classified as pathological and 78 (42.2%) as normal. Women positive for HPV16/18/45 were 4.2 times more likely to harbor cervical intraepithelial neoplasia grade 2 or worse (CIN2+) than those with other HPV types. The specificity of HPV 16/18/45 genotypes for detection of high-grade lesions among HR-HPV positive women was higher than that of VIA/VILI in all age groups. The sensitivity and specificity of VIA/VILI in detecting CIN2+ among HPV positive women were 80% and 44%, respectively. Overall, 110/121 screen-positive women (90.9%) were eligible for, and were treated with, thermocoagulation. An HPV-based screen-and-treat approach is feasible in a low-resource context and may contribute to improving the effectiveness of CC prevention programs. Immediate thermocoagulation treatment for women who are HPV16- and/or HPV18/45-positive is a practical approach for the treatment of CIN2+. The combination of HPV-testing and VIA/VILI for CC screening might reduce overtreatment.
宫颈癌（CC）是撒哈拉以南非洲地区女性癌症相关死亡的主要原因，主要是因为获得有效筛查和预防性治疗的机会有限。我们的目的是评估在资源匮乏地区基于人乳头瘤病毒（HPV）的宫颈癌筛查与治疗方法的可行性。我们通过在喀麦隆雅温得区医院开展的宫颈癌筛查活动招募了1012名30至49岁的女性。参与者进行HPV自我采样，使用即时检测的Xpert HPV检测法检测高危型HPV（HR-HPV）DNA。所有HPV阳性女性均被邀请接受醋酸和卢戈氏碘液目视检查（VIA/VILI），以排除宫颈癌或进行分流。同时还采集了宫颈样本用于组织学分析。HPV 16/18/45阳性以及其他HR-HPV且VIA/VILI病理检查阳性的女性被选择接受热凝治疗。研究人群中的HPV感染率为18.5%（n = 187）；其中，HPV16、HPV18/45和其他HR-HPV类型阳性的病例分别为20例（10.6%）、42例（22.3%）和140例（74.9%）。总体而言，107/185（57.8%）的VIA/VILI检查被分类为病理检查阳性，78例（42.2%）为正常。HPV16/18/45阳性的女性患宫颈上皮内瘤变2级或更高级别（CIN2+）的可能性是其他HPV类型女性的4.2倍。在所有年龄组中，HPV 16/18/45基因型在HR-HPV阳性女性中检测高级别病变的特异性高于VIA/VILI。VIA/VILI在HPV阳性女性中检测CIN2+的敏感性和特异性分别为80%和44%。总体而言，110/121名筛查阳性女性（90.9%）符合热凝治疗条件并接受了治疗。基于HPV的筛查与治疗方法在资源匮乏地区是可行的，可能有助于提高宫颈癌预防项目的有效性。对HPV16和/或HPV18/45阳性女性立即进行热凝治疗是治疗CIN2+的一种实用方法。HPV检测和VIA/VILI联合用于宫颈癌筛查可能会减少过度治疗。
