Audit of Cervical Cancer Screening and Colposcopy Attendance in Rural South Africa

Yas Knegt

Abstract

Women in developing countries generally lack access to cervical cancer preventive services. An audit was performed in rural South Africa to test the hypothesis that women do not follow (pre-)cancerous cervical disease treatment sufficiently, to understand the possible reasons for this non-attendance behavior, and to evaluate other published diagnostic and treatment initiatives. Based on Pap smear and colposcopy attendance data, including age, HIV status, month of attendance, and cervical intraepithelial neoplasia (CIN) staging, relatively few patients (54% of 928 patients) visited a colposcopy clinic following an abnormal Pap smear. Although these co-factors do not explain this high non-attendance rate, HIV status was an important cofactor; percentage-wise, HIV positivity correlated with a higher attendance rate. Screening methods that use mobile teams to successfully deliver cost-effective on-the-spot treatment warrant further attention. (Afr J Reprod Health 2014; 18[4]: 70-78).

 

Keywords: cervix, cancer, HIV, preventive screening, colposcopy, South Africa 

 

Résumé

 Les femmes des pays en développement n’ont généralement pas accès aux services de prévention du cancer du col utérin. Une vérification a été réalisée en Afrique du Sud rurale pour tester l'hypothèse que les femmes ne suivent pas le (pré) traitement de la maladie cancéreuse du col suffisamment pour comprendre les raisons possibles de ce comportement de la non présence et d'évaluer d'autres initiatives diagnostic et de traitement publiées. Se basant sur les analyses  de Papanicolaou et les données de fréquentation de la colposcopie, y compris l'âge, le situation du VIH, le mois de fréquentation, et la néoplasie intra épithéliale cervicale  (NIC) de mise en scène, relativement peu de patientes (54% des 928 patientes) ont visité une clinique de colposcopie suite à un frottis anormal. Bien que ces co-facteurs ne expliquent pas ce taux de non-participation élevé, l’etat du VIH était un cofacteur important; en pourcentage, la séropositivité corrélée avec un taux de participation plus élevé. Les méthodes de dépistage qui se servent des équipes mobiles pour livrer avec succès  un traitement rentable et sur le terrain méritent une attention particulière. (Afr J Reprod Health 2014; 18[4]: 70-78).

 

Mots-clés: col, cancer,  dépistage préventif, colposcopie, Afrique du Sud VIH

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