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- Southern African Journal of Gynaecological Oncology
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- Volume 5, Issue sup-1, 2013
Southern African Journal of Gynaecological Oncology - Supplement 1, January 2013
Supplement 1, January 2013
Source: Southern African Journal of Gynaecological Oncology 5 (2013)More Less
In 2009, The Cancer Association of South Africa (CANSA) awarded its biggest research grant to date to the HPV Cervical Cancer Research Fund, under the auspices of Prof Greta Dreyer. This grant enabled a group of researchers from different disciplines to conduct a project to investigate large-scale cervical cancer screening of peri-urban women using cytology and molecular testing. The main findings of this study, performed in the Tshwane Health District, are reported in this supplement which is introduced by Dr Carl Albrecht, Head of Research, CANSA.
Author Carl AlbrechtSource: Southern African Journal of Gynaecological Oncology 5, pp 3 –4 (2013)More Less
The war on cancer started in earnest in 1971 when Richard Nixon empowered the National Cancer Institute to eradicate cancer. Forty years later, after spending close on a trillion dollars and involving approximately 100 000 cancer researchers, roughly 50% of the cancer problem remains to be solved. Achieving this could take another 40 years.
Alternative sampling methods for cervical cancer screening : practical perspectives from the laboratory : review articleSource: Southern African Journal of Gynaecological Oncology 5, pp 5 –9 (2013)More Less
The coverage of cervical cancer screening in South Africa is inadequate, with an estimated 8.8-million unscreened women who are mainly serviced by the public health sector in lower-resourced areas. Alternative screening options need to be considered. Every step in the screening process needs to be critically evaluated to design a practical programme without a bottleneck, to deliver maximum benefit with limited available resources. Patient self-sampling has been identified as an acceptable method of specimen collection for many women. Patient self-sampling, combined with high-risk human papillomavirus-based testing, has the potential to increase cervical cancer screening coverage, especially in areas where screening is inadequate.
Challenges in preventative care and research in primary healthcare facilities : information obtained during implementation of a cervical cancer screening project in the Tshwane Health District : original researchSource: Southern African Journal of Gynaecological Oncology 5, pp 10 –14 (2013)More Less
Objectives : The aim was to identify challenges to conducting research and obstacles to successful cervical cancer screening in public sector primary healthcare clinics (PHCs).
Design : Qualitative research was conducted, using semi-structured interviews.
Setting and subjects : Study staff and healthcare workers involved in the implementation of a large screening study conducted in existing primary healthcare facilities were interviewed during the study period.
Outcome measures : The outcome measure was qualitative data on problems and obstacles to research and cervical cancer screening in public health facilities.
Results : Twenty-one participants were interviewed at intervals over three years. It was found that clinical research could only be conducted in PHC facilities if no additional burden was placed on the staff or facilities. Preventative care was not found to be part of the focus of the clinics, which rather concentrated on disease. The need for gynaecological examinations was identified as an important obstacle to screening at PHC clinics. Self-sampling was widely accepted, as was cervical sampling for human papillomavirus. Reporting of screening results to patients presented a huge challenge to PHC facilities. Ineffective communication of the results was identified as another major obstacle to effective screening.
Conclusion : Future cervical cancer screening methods should include sampling, without the need for an intimate examination. Finding new ways of calling women in for structured screening at regular intervals and reporting the results to them requires urgent attention.
Human papillomavirus DNA testing on self-collected vaginal tampon samples as a cervical cancer screening test in a Gauteng population : original researchSource: Southern African Journal of Gynaecological Oncology 5, pp 15 –20 (2013)More Less
Background : There is a need to simplify cervical cancer screening to reach more women. Tampon-collected specimens can be tested using molecular methods, but this type of self-screening has not been properly evaluated as a screening method in South Africa before. The objective of this study was to evaluate human papillomavirus (HPV) DNA testing of self-collected tampons as a screening method in an urban and peri-urban population in Gauteng by comparing the results with the current standard of conventional cytology. In addition, HPV prevalence, type, distribution and incidence of cytological abnormalities in this population are described.
Method : Seven hundred and twenty women attending public healthcare facilities in and around Tshwane, Gauteng province, were invited to participate. The women collected a tampon sample for molecular testing, and were then screened by healthcare workers collecting a conventional cervical cytology smear. HPV testing was undertaken using the Linear Array® HPV Genotyping Test (Roche Molecular Systems).
Results : Data for analysis were available for 631 women. Three hundred and fifty-four (58%) were positive for high-risk HPV, while (15.4%) had an abnormal cytology result. Women aged 30-39 years had the highest prevalence of both high-risk HPV (75%) and abnormal cytology (22%). Infection with multiple types was common. Higher-risk viruses were not over-represented in, and no dramatic decrease in HPV prevalence was observed in, older women. Cytological abnormalities were detected in only 3.74% of women who tested negative for high-risk HPV, but were found in 24.2% of high-risk HPV positive women.
Conclusion : HPV testing on self-collected tampon samples was feasible, highly sensitive and demonstrated a high negative predictive value for current cytological abnormalities in this population.
Human papillomavirus-type distribution in South African women without cytological abnormalities : a peri-urban study : original researchSource: Southern African Journal of Gynaecological Oncology 5, pp 21 –27 (2013)More Less
Objectives : Knowledge of human papillomavirus (HPV) distribution in the general population is crucial for the development of new HPV vaccines and to provide a baseline from which to monitor the impact of current HPV vaccines in the future. HPV-type distribution in the Tshwane area, South Africa, might be different to that in other regions and countries.
Design : This was a retrospective descriptive study, representative of women without cervical cytological abnormalities.
Setting and subjects : Women attending primary health clinics in the region of Tshwane were screened for cervical abnormalities with conventional cytology.
Outcome measures : Women without cytological abnormalities were included, and HPV DNA typing, using HPV Linear® Array Genotyping Test (Roche Molecular Systems, Branchburg, USA) was performed on all women.
Results : Demographic data were available for 1 238 patients. The mean age was 40.9 years. The majority of the women (14.6%) were between 35 and 39 years of age. 19.4% of women were younger than 30 years of age. The prevalence of HPV types was 67.1% and high-risk HPV infections, 44.9%. The average number of HPV-type infections was 3.2 in the 845 patients with HPV infections. The most common high-risk virus was HPV 16 (10.8%), followed by HPV 51 (9.3%), and HPV 58 (7.9%). HPV 18 was observed in 5.9%, and HPV 45 in 7.5%, of participants. HPV 62 (15.6%) and HPV 84 (14.4%) were the most prevalent low-risk types.
Conclusion : HPV infections were highly prevalent in this population. The prevalence of HPV 16 and 18 was higher than that reported in other world regions. HPV 16 was the most prevalent high-risk type infection in women without cytological abnormalities. HPV infections other than HPV 16 and 18 were also prevalent, and this is important for future vaccine development.
The effect of human immunodeficiency virus prevalence on the epidemiology of conventional cervical cytological abnormalities : an institutional experience : original researchSource: Southern African Journal of Gynaecological Oncology 5, pp 28 –32 (2013)More Less
Objectives : Despite a shift towards other screening modalities, cervical cytology still has an important screening function in many settings. The worldwide human immunodeficiency virus (HIV) epidemic has impacted severely on cervical cancer, resulting in women presenting at a younger age with more advance disease and poorer prognosis. The objective of this study was to compare different datasets from different time periods to assess the possible impact of HIV infection on the epidemiological characteristics of conventional cervical cytology screening results.
Design : The design was a comparative overview of two different cervical cytology datasets collected at different times.
Settings and subjects : Conventional cervical cytology screening data from non-pregnant patients at the gynaecological outpatient service of the Pretoria Academic Complex from 1991-2000, and data from pregnant patients attending the Kalafong Hospital antenatal clinic in 1993-1994 and 2008, were analysed.
Outcome measures : Abnormal smear rates, the distribution of different abnormal smears and HIV prevalence in pregnant women taking part in the annual, National Antenatal Sentinel HIV and Syphilis Prevalence Survey.
Results : The high prevalence of HIV in South Africa is associated with a higher prevalence of abnormal smears. It is also associated with a change in the distribution of detected abnormalities. High-grade squamous intraepithelial lesions (HSIL) are now much more common than low-grade squamous intraepithelial lesions (LSIL). The most pronounced change has been a shift in the ratio of LSIL to HSIL, where the value has changed from > 1 to < 1.
Conclusion : The rate of abnormal smears as well as the distribution of abnormalities of conventional cervical cytology in South Africa has changed. It is possible that this change is associated with the high prevalence of HIV infection.