Farida Selmouni1, Catherine Sauvaget2, Latifa Belakhel3, Eric Lucas4, Mohamed Khouchoua5, Rengaswamy Sankaranarayanan4. 1. Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain; Department of Scientific Research, Continuous Training and Cooperation, Higher Institute of Nursing Professions and Techniques of Health of Rabat, Rabat, Morocco. 2. Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France. Electronic address: sauvagetc@iarc.fr. 3. Department of Scientific Research, Continuous Training and Cooperation, Higher Institute of Nursing Professions and Techniques of Health of Rabat, Rabat, Morocco. 4. Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France. 5. Department of Infrastructure and Provincial Ambulatory Actions, Regional Direction of Health Meknès-Tafilalet, Meknès, Morocco.
Abstract
OBJECTIVE: To evaluate a pilot program for early detection of cervical cancer using visual inspection with acetic acid (VIA) and the loop electrosurgical excision procedure (LEEP) in one region of Morocco. METHODS: A descriptive analysis of the screening outcome measures of 43 participating primary care units and one reference center for LEEP was conducted in Meknès-Tafilalet between January 1, 2011, and December 31, 2013. Data on the number of participants, VIA results, colposcopy, and treatment were used in analyses. RESULTS: Of the 308 197 women in the target age group (30-49 years), 18 586 (6.0%) were screened by VIA. Positive screening test results were recorded for 1628 (8.8%) women, of whom 1144 (70.3%) received diagnostic confirmation by colposcopy. Of the 87 (7.6%) women with cervical intraepithelial neoplasia, only 16 (18.4%) underwent LEEP; three cases of invasive cervical cancer were diagnosed. CONCLUSION: Issues with implementation of the screening program were found, including low compliance and a low treatment rate of cervical intraepithelial neoplasia by LEEP. By contrast, high rates of colposcopy referral were observed. Screen-and-treat by ablative methods (e.g. thermocoagulation) should be considered to increase treatment rates at national scale-up.
OBJECTIVE: To evaluate a pilot program for early detection of cervical cancer using visual inspection with acetic acid (VIA) and the loop electrosurgical excision procedure (LEEP) in one region of Morocco. METHODS: A descriptive analysis of the screening outcome measures of 43 participating primary care units and one reference center for LEEP was conducted in Meknès-Tafilalet between January 1, 2011, and December 31, 2013. Data on the number of participants, VIA results, colposcopy, and treatment were used in analyses. RESULTS: Of the 308 197 women in the target age group (30-49 years), 18 586 (6.0%) were screened by VIA. Positive screening test results were recorded for 1628 (8.8%) women, of whom 1144 (70.3%) received diagnostic confirmation by colposcopy. Of the 87 (7.6%) women with cervical intraepithelial neoplasia, only 16 (18.4%) underwent LEEP; three cases of invasive cervical cancer were diagnosed. CONCLUSION: Issues with implementation of the screening program were found, including low compliance and a low treatment rate of cervical intraepithelial neoplasia by LEEP. By contrast, high rates of colposcopy referral were observed. Screen-and-treat by ablative methods (e.g. thermocoagulation) should be considered to increase treatment rates at national scale-up.
Authors: Nora Hamdiui; Mart L Stein; Aura Timen; Danielle Timmermans; Albert Wong; Maria E T C van den Muijsenbergh; Jim E van Steenbergen Journal: BMC Med Date: 2018-03-29 Impact factor: 8.775