Treatment outcomes of patients with precancerous cervical lesions managed by Cryotherapy and loop Electrosurgical procedure done at Ocean Road Cancer Institute

Abstract

ABSTRACT Background: Globally the burden of cancer is increasing and noted to be a leading cause of morbidity and mortality contributed by non-communicable diseases. Cervical cancer as of the Global Cancer Observatory (GLOBOCAN) 2022 is the fourth most frequent cancer in women globally accounting for 662,301 new cancer cases and 348,874 cancer deaths. As per this report the region-specific incidence and mortality for East Africa, cervical cancer is the leading cancer with 40.1/100,000 and 28.6/100,000 respectively. In countries like Denmark and Norway cervical cancer was reduced by 50% between 1960s and 1970s(1). The main drivers being a high prevalence of high-risk human papilloma virus (HR HPV), human immunodeficiency virus (HIV) coupled with the lack of effective sustained programs for cervical cancer screening which is in low- and middle-income countries (LMIC). This has led to the introduction of more cost effective and accessible screening services to these countries. There is lack of data looking into the effectiveness of these cost-effective screening services especially those coupled with treatment of precancerous cervical lesions. Objective: This study aimed to estimate the prevalence of precancerous cervical lesions, their treatment outcomes and investigate predictors within the sociodemographic and clinicopathologic factors of clients screened for cervical cancer at Ocean Road Cancer Institute (ORCI). Materials and methods: This study was a retrospective cohort study conducted at the ORCI located in Dar es salaam, Tanzania. It included all clients who visited the institute for cervical cancer screening from January 2020 to December 2022 as the study population. The end point was 1 year follow-up results on re-screening after treatment for a precancerous cervical lesion. The computing tool used for statistical analysis and data visualization was statistics and data software (Stata version 17.0). Quantitative data was summarized using mean and standard deviation while categorical data was summarized using proportions. The Chi test was used to compare proportions and univariate and multivariate analysis used to evaluate factors that are outcome predictive. Results: Clients who were found to have precancerous cervical lesions on visual inspection with acetic acid/ visual inspection with Lugol’s iodine (VIA/VILLI) corresponded to 4.8% of all 5074 clients screened, characterized with majority being within the age of 35-45, interestingly associated with nulliparity and 4 times more prevalent in clients who were HIV positive (adjusted odds ratio (aOR)) = 4.47, 95% CI: 3.28-6.09, p<0.001). The 1-year follow-up results on re-screening after treatment of precancerous lesions corresponded to 78.2% cure rate of the 78 clients who turned up for follow. Results also reveal that women living with HIV were 3.72 times more likely to turn positive after one year of follow-up (aOR=3.72, 95% CI: 1.03-13.47, p-value = 0.045). Conclusions: In the screening and post treatment screening of clients for cervical cancer, HIV was found to be a significant predictor of both prevalence and treatment failure of precancerous lesions detected using VIA/VILLI. Future research should be directed towards this cohort of clients on customized screen and treat protocols to halt their potential progression to cervical cancer.