Low-cost cervical cancer screening in Zambia.
Article Type: Brief article
Subject: Cervical cancer (Prevention)
Cervical cancer (Diagnosis)
Cancer (Diagnosis)
HIV patients (Medical examination)
Papillomavirus infections (Prevention)
Pub Date: 05/01/2010
Publication: Name: Reproductive Health Matters Publisher: Reproductive Health Matters Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2010 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2010 Source Volume: 18 Source Issue: 35
Geographic: Geographic Scope: Zambia Geographic Code: 6ZAMB Zambia
Accession Number: 236247771
Full Text: Cervical cancer kills more women than any other cancer in low-income nations, particularly affecting those with HIV. With increasing access to antiretroviral therapy (ART), HIV-positive women may now live long enough for human papillomavirus infections to progress to cervical cancer. Nurse-led screen-and-treat services, co-located with ART programmes, were set up at 15 public-sector sites in Lusaka as part of the Cervical Cancer Prevention Programme in Zambia. Nurses evaluated 6,572 HIV-positive patients with visual inspection and digital cervicography and 3,523 (54%) were screen positive. 2,062 (59%) of these were offered immediate cryotherapy, of whom 1,603 (78%) underwent the procedure. The additional 1,461 (41%) were referred for further evaluation of whom 715 (49%) underwent histological confirmation. Clinical and surgical staging of these revealed 235 pre-cancers, 79 early-stage cancers and 36 late-stage cancers. Using published estimates of disease progression and cure/prevention rates and assuming all women receive treatment, researchers estimated that the programme prevented 203 invasive cervical cancer cases--equivalent to one case for every 32.3 HIV-positive women screened. This screening costs $1 compared to Pap smears which are $15, mainly because it is nurse-led. Other countries such as Botswana, Cameroon and Tanzania are interested in replicating it. Early detection can reduce morbidity and mortality from cervical cancer but there are challenges around patient attrition, the unknown progression of the cancer in HIV-positive women, and how women at different clinical stages of HIV react to treatment. (1,2)

(1.) Parham G, Mwanahamuntu M, Sahasrabuddhe V, et al. Effectiveness of a program to prevent cervical cancer among HIV-infected women in Zambia. Presented at the 17th Conference on Retroviruses and Opportunistic Infections (CROI), February 2010. At: .

(2.) Zambia: Cervical cancer screening saves lives. IRIN PlusNews, 18 February 2010.
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