Cervical Cancer Screening in Cameroon
Cervical Cancer Screening in Cameroon
Human immunodeficiency virus-infected (HIV[+]) women have a several-fold increased risk of
 invasive cervical cancer (ICC) as well as increased risk of cervical pre-cancer. In low- and
 middle-income countries (LMICs), ICC is the 1st or 2nd most common cause of cancer and
 cancer-related death in women. Rates of ICC and ICC-related mortality are particularly high
 in Sub-Saharan Africa, which also has the highest rates of HIV infection in the world.
 Although prophylactic HPV vaccines may be the optimal cervical cancer prevention strategy,
 2-3 generations of at-risk HIV[+] and HIV[-] women are already highly exposed to human
 papillomavirus (HPV) and would not benefit from (and will not be immunized with) HPV vaccine.
 Thus cervical cancer screening is needed for the foreseeable future. However, Pap testing is
 expensive and requires a complex clinical and lab infrastructure that does not generally
 exist in LMICs; strategies based on high-risk HPV (hrHPV) testing or visual inspection after
 acetic acid (VIA) are promising but are either too non-specific, leading to over-referral for
 colposcopy or over-treatment, or are too insensitive, respectively. Thus, inexpensive, easily
 implemented, and effective cervical cancer screening methods are greatly needed in
 Sub-Saharan Africa, especially for HIV[+] women. This cervical cancer screening study of
 1,200 women (800 HIV[+] and 400 HIV[-] women), aged 25-59 years, living in Cameroon, utilized
 our existing research site. The investigators evaluated screening tests (hrHPV testing, VIA
 and Pap), traditional triage tests (HPV16/18/45 detection, VIA, Pap), and promising new
 biomarkers for triage (Ki-C67, TOP2a, CDKN2A, and HPV viral load) of screen-positive women.
 All screen positives underwent rigorous disease ascertainment to obtain unbiased estimates of
 sensitivity, specificity, and positive and negative predictive value. The goal of this study
 was to establish the foundation and capacity for future studies designed to reduce the burden
 of HPV-associated cancers in the Cameroon population. It will inform Cameroon and other
 countries with high HIV burdens on the best strategies for cervical cancer screening in their
 HIV[+] and HIV[-] women.
Inclusion Criteria:

 -  Women living in Limbe town and neighborhood

 -  Confirmed to be HIV[+] or HIV[-]

 -  Have never undergone cervical cancer screening, with no history of ICC

 -  Willing and able to competently understand and provide written, informed paper-based
 consent

 -  Women who are having a menstrual period will be deferred for 2 weeks from
 participating in the study

 Exclusion Criteria:

 -  Pregnant women

 -  Women with signs of abnormalities

 -  Non-menstrual bleeding suggestive of ICC

 -  Without a cervix because they have undergone hysterectomy

 -  Based on the judgment of the clinicians not sufficiently healthy to participate in a
 research study