RT Journal Article
SR Electronic
T1 The Capulana study: a prospective evaluation of cervical cancer screening using human papillomavirus testing in Mozambique
JF International Journal of Gynecologic Cancer
JO Int J Gynecol Cancer
FD BMJ Publishing Group Ltd
SP 1292
OP 1297
DO 10.1136/ijgc-2020-001643
VO 30
IS 9
A1 Mila P Salcedo
A1 Cristina Oliveira
A1 Viviane Andrade
A1 Arlete A N Mariano
A1 Dércia Changule
A1 Ricardina Rangeiro
A1 Eliane C S Monteiro
A1 Ellen Baker
A1 Natacha Phoolcharoen
A1 Melissa L Varon
A1 Joseph P Thomas
A1 Philip E Castle
A1 Jose Humberto T G Fregnani
A1 Kathleen M Schmeler
A1 Cesaltina Lorenzoni
YR 2020
UL http://ijgc.bmj.com/content/30/9/1292.abstract
AB Background Cervical cancer is the leading cause of cancer and related deaths among women in Mozambique. There is limited access to screening and few trained personnel to manage women with abnormal results. Our objective was to implement cervical cancer screening with human papillomavirus (HPV) testing, with navigation of women with abnormal results to appropriate diagnostic and treatment services.Methods We prospectively enrolled women aged 30–49 years living in Maputo, Mozambique, from April 2018 to September 2019. All participants underwent a pelvic examination by a nurse, and a cervical sample was collected and tested for HPV using the careHPV test (Qiagen, Gaithersburg, Maryland, USA). HPV positive women were referred for cryotherapy or, if ineligible for cryotherapy, a loop electrosurgical excision procedure. Women with findings concerning for cancer were referred to the gynecologic oncology service.Results Participants (n=898) had a median age of 38 years and 20.3% were women living with the human immunodeficiency virus. HPV positivity was 23.7% (95% confidence interval 21.0% to 26.6%); women living with human immunodeficiency virus were twice as likely to test positive for HPV as human immunodeficiency virus negative women (39.2% vs 19.9%, p<0.001). Most HPV positive women (194 of 213, 91.1%) completed all steps of their diagnostic work-up and treatment. Treatment included cryotherapy (n=158, 77.5%), loop electrosurgical excision procedure (n=30, 14.7%), or referral to a gynecologist or gynecologic oncologist (n=5, 2.5%). Of eight invasive cervical cancers, 5 (2.8%) were diagnosed in women living with human immunodeficiency virus and 3 (0.4%) in human immunodeficiency virus negative women (p=0.01).Conclusion Cervical cancer screening with HPV testing, including appropriate follow-up and treatment, was feasible in our study cohort in Mozambique. Women living with human immunodeficiency virus appear to be at a significantly higher risk for HPV infection and the development of invasive cervical cancer than human immunodeficiency virus negative women.