Prevalence Of Cervical Intraepithelial Neoplasia Among Women Who Screen Via/vili Positive:are We Overtreating With Screen And Treat Approach?

Abstract

Background: Effective screening for premalignant cervical lesions remains a challenge in sub Saharan Africa including Kenya. This is due to inadequate infrastructure, skilled personnel and cost required for pap smear and HPV DNA screening programs. This has led to late diagnosis of invasive cancer with attendant high morbidity and mortality. The screen and treat strategy using visual methods like visual inspection with acetic acid and visual inspection with lugol’s iodine (VIA/VILI) has been recommended by WHO in such settings to reduce cost and loss to follow up. However, no local evaluation of the VIA/VILI screened positive congruence to colposcopy biopsy and histology has been done. This is needed to estimate possible overtreatment since guidelines for similar strategy using pap smear sets overtreatment level at less than 10% Broad objective: To determine the proportion of women with abnormal histology findings following a positive VIA/VILI screen at Kenyatta National Hospital between January 2012 and December 2016 and to determine the histological classification. Methodology Study design: This was a cross-sectional study in which records of 425 women who underwent colposcopy guided biopsy and histology at Kenyatta National Hospital after positive VIA/VILI screening were reviewed and agreement between the screening results and biopsy histology results assessed. Study setting: This was a hospital-basedstudy conducted at the Kenyatta National Hospital reproductive health clinic 66. Study population: Women with positive VIA/VILI screening results who underwent colposcopy guided biopsy and histology at KNH between 2012 and 2016 and had histology results available in the files. xiii Sample size: Records of 425 patients were used for the study. Data collection: Data was collected using a standard data abstraction form. Data analysis: Data was analyzed using SPSS version 21.0 for statistical analysis. Categorical data was summarized into percentages and continuous variables into means. The proportion of women with CIN was presented as a percentage with 95% confidence interval. CIN classification of the true positives was presented as percentages. Associations between the CIN and clinical characteristics was done using chi square test of associations. Results: Out of 492 patients screened, 425 were included in the analysis. About half (53.4%) of the women had abnormal histology findings that is CIN I, CIN II, CIN III or microinvasive disease. Those with CIN II and above were 34.8%. Patients with HIV infection were found to be more likely to have CIN II and above compared to the non-infected. Conclusion: This study shows low congruence between VIA/VILI screening and presence of CIN II and above indicating possible overtreatment of 65% using screen and treat approach. Guidelines to minimize levels of overtreatment should be developed before implementing the screen and treat strategy using VIA/VILI.