Cervical Cancer Screening Program using HPV Subtyping See and Treat Cryotherapy in Milot, Haiti

As infectious diseases have significantly decreased their impact on the lifespan of persons living in Haiti, cancer and other chronic illnesses have emerged as large contributors to morbidity and mortality. Cervical cancer incidence (93.9/100,000) and mortality rate (53.5/100,000) are considered among the highest in the developed, and developing worlds. Efforts to decrease the burden of cervical cancer have focused on early detection including PAP smear screening, see and treat models, and HPV vaccination campaigns. There is an absence, however, of convincing prevalence data on abnormal cervical pathology and HPV serotypes. The goal of this pilot project was to 1) establish an initial prevalence study of abnormal cervical pathology and HPV subtypes using PAP smears, 2) implement a see and treat model using cryotherapy and 3)evaluate the intervention. Of 250 women recruited from church, 31 of the pathology reports showed high or low grade squamous cell lesions, 16 returned for follow up care using see and treat, and 11 of the 16 tested positive for at least one strain of HPV known to be of high risk (16,18). Based on WHO guidelines, we recommend using see and treat cryotherapy in similar low resource settings. Recommendations for or against vaccination as a means to decrease the burden of disease will require further serotype investigations.