TY - JOUR
T1 - The Capulana study
T2 - A prospective evaluation of cervical cancer screening using human papillomavirus testing in Mozambique
AU - Salcedo, Mila P.
AU - Oliveira, Cristina
AU - Andrade, Viviane
AU - Mariano, Arlete A.N.
AU - Changule, Dércia
AU - Rangeiro, Ricardina
AU - Monteiro, Eliane C.S.
AU - Baker, Ellen
AU - Phoolcharoen, Natacha
AU - Varon, Melissa L.
AU - Thomas, Joseph P.
AU - Castle, Philip E.
AU - Fregnani, Jose Humberto T.G.
AU - Schmeler, Kathleen M.
AU - Lorenzoni, Cesaltina
N1 - Funding Information:
Funding This research was supported in part by the National Institutes of Health (NIH) through MD Anderson’s Cancer Center Support grant P30CA016672; the Anadarko Petroleum Corporation; the Prevent Cancer Foundation; the Dunaway Family Fund; the Joe Family Fund; the Giles-O’Malley Foundation; as well as by the support of the American people through the United States Agency for International Development (USAID) and was prepared under the Cooperative Agreement AID-OAA-A-11-00012, Partnerships for Enhanced Engagement in Research (PEER) Program.
Publisher Copyright:
© 2020 International Journal of Gynecological Cancer
PY - 2020/9/1
Y1 - 2020/9/1
N2 - 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.
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.
KW - cervix uteri
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UR - http://www.scopus.com/inward/citedby.url?scp=85090508260&partnerID=8YFLogxK
U2 - 10.1136/ijgc-2020-001643
DO - 10.1136/ijgc-2020-001643
M3 - Article
C2 - 32737122
AN - SCOPUS:85090508260
SN - 1048-891X
VL - 30
SP - 1292
EP - 1297
JO - International Journal of Gynecological Cancer
JF - International Journal of Gynecological Cancer
IS - 9
ER -
