Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Population Services International, Washington, District of Columbia, USA.
Int J Gynecol Cancer. 2023 Dec 4;33(12):1869-1874. doi: 10.1136/ijgc-2023-004958.
To evaluate cervical cancer screening with primary human papillomavirus (HPV) testing in Mozambique, a country with one of the highest burdens of cervical cancer globally.
Women aged 30-49 years were prospectively enrolled and offered primary HPV testing using either self-collected or provider-collected specimens. Patients who tested positive for HPV underwent visual assessment for treatment using visual inspection with acetic acid to determine eligibility for thermal ablation. If ineligible, they were referred for excision with a loop electrosurgical excision procedure, for cold knife conization, or for cervical biopsy if malignancy was suspected.
Between January 2020 and January 2023, 9014 patients underwent cervical cancer screening. Median age was 37 years (range 30-49) and 4122 women (45.7%) were patients living with HIV. Most (n=8792, 97.5%) chose self-collection. The HPV positivity rate was 31.1% overall and 39.5% among patients living with HIV. Of the 2805 HPV-positive patients, 2588 (92.3%) returned for all steps of their diagnostic work-up and treatment, including ablation (n=2383, 92.1%), loop electrosurgical excision procedure (n=169, 6.5%), and cold knife conization (n=5, 0.2%). Thirty-one patients (1.2%) were diagnosed with cancer and referred to gynecologic oncology.
It is feasible to perform cervical cancer screening with primary HPV testing and follow-up in low-resource settings. Participants preferred self-collection, and the majority of screen-positive patients completed all steps of their diagnostic work-up and treatment. Our findings provide important information for further implementation and scale-up of cervical cancer screening and treatment services as part of the WHO global strategy for the elimination of cervical cancer.
评估莫桑比克的宫颈癌筛查，该国是全球宫颈癌负担最重的国家之一。
30-49 岁的女性前瞻性入组，并接受基于自我采集或医护人员采集标本的主要 HPV 检测。HPV 检测阳性的患者进行醋酸视觉评估以确定是否适合热消融治疗。如果不适合，将推荐其进行环形电切术、冷刀锥切术或怀疑恶性肿瘤时进行宫颈活检。
2020 年 1 月至 2023 年 1 月期间，9014 名患者接受了宫颈癌筛查。中位年龄为 37 岁（30-49 岁），4122 名女性（45.7%）为 HIV 感染者。大多数患者（n=8792，97.5%）选择自我采集。总 HPV 阳性率为 31.1%，HIV 感染者中 HPV 阳性率为 39.5%。在 2805 名 HPV 阳性患者中，2588 名（92.3%）返回进行了所有诊断和治疗步骤，包括消融（n=2383，92.1%）、环形电切术（n=169，6.5%）和冷刀锥切术（n=5，0.2%）。31 名患者（1.2%）被诊断为癌症并转诊至妇科肿瘤科。
在资源匮乏的环境中进行主要 HPV 检测和后续宫颈癌筛查是可行的。参与者更喜欢自我采集，大多数筛查阳性患者完成了所有诊断和治疗步骤。我们的发现为进一步实施和扩大宫颈癌筛查和治疗服务提供了重要信息，这是世卫组织消除宫颈癌全球战略的一部分。
