Cervical cancer screening in Cameroon, West Africa using visual inspection with acetic acid (VIA) and enhanced digital imaging (EDI)

BACKGROUND:

Invasive cervical cancer (ICC), caused by human papilloma virus (HPV), is the second most common cancer and the leading cause of cancer death among women in developing countries. Early detection and treatment of pre-cancer is compounded by limited resources and high prevalence of HIV. We describe a cancer screening and treatment program piloted in West Africa by the Cameroon Baptist Convention Health Board in collaboration with a program in Zambia.

METHODS:

The program uses EDI as an adjunct to VIA, instead of Pap smears, targeting HIV-infected women in support groups and health care workers. EDI uses an inexpensive digital camera to produce magnified cervical images visible to both patient and provider, web-based storage of patient data linked to the images for future comparison, consultation, and training, and immediate treatment of women who meet cryotherapy criteria. We analyzed patient data using STATA 10.0.

RESULTS:

From March 2007 through 2008, this pilot program screened 1725 women for cervical cancer, and treated 137 women with acetowhite lesions with cryotherapy and 29 women with loop electric excision procedures. Mean age of sexual debut was 18 years, mean sexual partners in the last 3 years was less than 1, 0.5% were current smokers, 1/3 were HIV positive, and 7.4% ever had a Pap smear.

DISCUSSION:

This pilot trans-Africa collaborative program shows great potential for upscaling to address the tremendous need in Cameroon and other African countries burdened by ICC and HIV.