Objective: The aim was to take stock of the screening and treatment of precancerous and cancerous lesions of the cervix in the health district of commune V of Bamako, the “ G ” point and the Gabriel Touré University Hospital in Bamako, Mali. Patients and Methods: This was a descriptive, cross-sectional, analytical study with retrospective and prospective data collection over an 8-year period from January 1, 2010 to December 31, 2017. This was a multi-center study. Results: From January 1, 2010 to December 31, 2017, 42 , 492 women were screened, representing a frequency of 24.30%. The median age of the women screened was 32 years; 25% were under the age of 25. Three-fourth of the women screened was in the 20 - 49 age group. Of the 22 , 842 women screened , 90.1% of them had a normal col to IVA/IVL. However , 4.1% of cervical positivity had with acetic acid and 5.1% of positivity to Lugol. 0.7% of the women screened clinically had cancerous lesions. Histologically, 96.5% of the women screened had a normal cervix with benign lesions. For pathological histological findings, we noted 2.6% of precancerous lesions and 0.8% of squamous cell carcinomas and 0.1% of adenocarcinoma. Conclusion: Improved screening indicators with IVA/IV reduce the rate of morbidity and mortality from cervical cancer.
Invasive cervical cancer is a slow-moving infectious disease that takes an average of 15 years to develop, from first infection with an oncogenic human papillomavirus (HPV) to various precancerous histological lesions associated with the persistence of infection [
A significant reduction in cervical cancer incidence and mortality has occurred over the past century in countries capable of implementing effective national screening programs [
Fortunately, other strategies for preventing cervical cancer have been studied and widely evaluated in these contexts [
Since 2001, Mali has implemented a cervical cancer screening program based on IVA/IVL. Unfortunately in 2010, screening coverage was less than 15%. In July 2016, the screening program was supported by mass screening campaigns to screen 70% of targets until 2017. And this program has been called “Weekend 70.”
Objective: to take stock of the screening and treatment of precancerous and cancerous lesions of the cervix in the health district of commune V of Bamako, point G and the Gabriel Touré University Hospital in Bamako, Mali.
This was a descriptive, cross-sectional, analytical study with retrospective and prospective data collection over an 8-year period from January 1, 2010 to December 31, 2017. This was a multi-center study (Reference Health Center of commune 5 of the District of Bamako to screen, Anatomy and Pathological Cytology Department of the University Hospital of Point “G” to examine biopsy parts and anatomopathological surgical parts and the Gabriel Touré Hospital which served as a center for the management and follow-up of women with precancerous and cancerous lesions in the cervix.
The sampling was exhaustive. The study population consisted of women in genital activity or menopause admitted to the various study centers. Inclusion criteria: All women in genital activity or menopause who were screened for precancerous and cancerous cervix lesions during the study period were included in the study period. Exclusion criteria: Some women were excluded from the study for pregnancy, diaper outcomes, menstruation, virginity, hysterectomy and confirmed cervical cancer followed by treatment.
The data was collected using a fact sheet established for this purpose and previously tested. The sources of data collection were: admission records, screening and treatment records for precancerous cervix lesions, and the operating theatre registry and then patient records. The variables studied were: epidemiological characteristics (age, risk factors, screening coverage), clinical aspects (IVA/IVL screening) and histological aspects.
The data was entered on SPSS 16.0. The statistical analyses were carried out with the SAS 9.4 software. Descriptive statistics were calculated and presented as an average, median and percentage depending on the type of variable. Pearson's Khi-Carré test was used to compare frequencies or prevalence. The Cochran-Armitage test was used to calculate the trend p value. The Odds Ratio (ORa) was used to assess the magnitude of risk with a 95% confidence interval (CI). Logistic regression analysis was used after adjustment to identify risk factors for precancerous and cancerous lesions of the cervix.
From January 1, 2010 to December 31, 2017, 42,492 women were screened on a target of 174,777 women, a frequency of 24.30%.
During these years of study, 24,842 women met the inclusion criteria and had a complete record with all the variables useful for the study’s needs.
The median age of the women screened was 32 years; 25% were under the age of 25. A similar proportion was over 40 years of age. Three-fourth of the women screened were in the 20 - 49 age group. Women aged 55 and over were the least represented by 5.7%.
From 2010 to 2012, the annual number of women screened for cervical cancer was less than 1000 women. Between 2013 and 2015, this number almost doubled to 2053 women screened in 2015. However, the highest number of screenings was recorded in 2016 and 2017 with 7197 and 9726 women screened respectively.
Screening coverage was over 35% for the 25 - 49 age group. It was 31.9% and 23.1% among women aged 50 - 54 and 55 - 59, respectively. Screening coverage was less than 15% among people aged 60 and over.
Among the risk factors studied in our series, variables such as age, diet, marital diet, use of contraceptive methods were measured statistically with a calculation of the Odds ratio.
Of the 22,842 women screened 90.1% of them had a normal col to IVA/IVL. However, 4.1% of cervical positivity with acetic acid and 5.1% of positivity to Lugol. 0.7% of the women screened clinically had cancerous lesions.
Anatomopathically, various histological lesions have been observed for precancerous lesions, squamous cell carcinoma and adenocarcinomas. Indeed, among the women screened 96.5% had a normal cervix with benign lesions. For those with pathological histological findings, 2.6% had a histology with precancerous lesions and 0.8% had squamous cell carcinomas. A low rate of 0.1% adenocarcinoma was recorded in our series.
In the literature, the frequency of precancerous lesions is observed more in the 30 - 50 age group and that of cancerous lesions is the age group of 50 and over. This frequency was 24.30% in our series. Numerous studies in different countries have assessed the impact of knowledge on cervical cancer screening, such as the one in Nigeria, which found that half of women surveyed about their screening habits identified lack of knowledge as an important reason why they had not been screened [
| Variables measured | Ora | IC 95% | ||
|---|---|---|---|---|
| Age-to-year | ||||
| < 20 years | 1.00 | - | ||
| 20 - 29 years | 2.45 | 1.27 | 4.74 | |
| 30 - 39 years | 5.35 | 2.78 | 10.33 | |
| 40 - 49 years | 7.76 | 3.99 | 15.10 | |
| 50 - 59 years | 12.09 | 6.17 | 23.69 | |
| 60 - 69 years | 20.70 | 10.27 | 41.72 | |
| 70 years and over | 34.61 | 16.30 | 73.52 | |
| Gestity | ||||
| Nulligeste | 1.00 | - | ||
| Primigeste | 1.71 | 1.07 | 2.73 | |
| Paucigeste | 1.24 | 0.79 | 1.93 | |
| Multigeste | 1.60 | 1.03 | 2.49 | |
| Large multigeste | 2.14 | 1.37 | 3.36 | |
| Marital diet | ||||
| Monogamy | 1.00 | - | ||
| Polygamy | 1.03 | 0.89 | 1.20 | |
| Single | 0.48 | 0.38 | 0.61 | |
| Method use Contraceptive | ||||
| Yes | 0.92 | 0.79 | 1.08 | |
| No | 1.00 | - | ||
| Screening Result | Effectifs | Frequency (%) | ||
| IVA/IVL normal | 22,321 | 90.1 | ||
| IVA positif | 1107 | 4.1 | ||
| IVL positif | 1256 | 5.1 | ||
| Suspicion of neoplasia | 164 | 0.7 | ||
| Total | 24,842 | 100 | ||
| Results of Histology | Effectifs | Frequency (%) |
|---|---|---|
| Normal/Benign Lesions | 23,986 | 96.5% |
| Precancerous injuries | 620 | 2.6% |
| Squamous cell carcinoma | 214 | 0.8% |
| Adenocarcinoma | 22 | 0.1% |
| Total | 24,842 | 100% |
This relationship is poorly defined in the literature where most of the authors are more interested in the relationship between parity and pre-cancerous and cancerous of the cervix. We looked at the relationship between gestity and the occurrence of precancerous and cancerous lesions. This relationship is poorly defined in the literature where most authors are more interested in the relationship between parity and precancerous and cancerous lesions of the cervix. Thus, in our study, we found a statistically significant link between the number of pregnancies (gestity) and the risk of developing precancerous and cancerous lesions of the cervix. Statistical tests carried out to measure this gestity gave us the following values: an Odds Ratio of 1.60 with a 95% CI of [1.03 - 2.49] multigeste, a Odds Ratio of 1.24 with a 95% CI of [0.79 - 1.93] of paucigeste , a Odds Ratio of 1.71 with a 95% CI of [1.07 - 2.73] of primigeste and a Odds Ratio of 1.00 nulligeste.
Assumptions such as increased hormone levels and altered immune response have been made to explain the increased risk of precancerous or cancerous cervix lesions with pregnancy and childbirth [
Also, it has been shown that the processing area remains longer on exocol in multiparous women and thus facilitates direct exposure to HPV and potential cofactors [
Our logistic regression analysis shows that age was strongly associated with the risk of precancerous and cancerous cervical lesions. Our logistic regression analysis shows that age was strongly associated with the risk of precancerous and cancerous cervical lesions. The risk of these lesions was increased 34.61 times in women aged 70 and over when compared to women under the age of 20. The risk of these lesions was increased 34.61 times in women aged 70 and over when compared to women under the age of 20. In addition, large multigesity was also associated with an increased risk of precancerous and cancerous lesions of the cervix compared to nulligest (ORa - 2.14; In addition, large multigesity was also associated with an increased risk of precancerous and cancerous lesions of the cervix compared to nulligest (ORa - 2.14; 95% CI: 1.37 - 3.36). 95% CI: 1.37 - 3.36). It is clear that age is a risk factor for precancerous and cancerous lesions of the cervix. It is clear that age is a risk factor for precancerous and cancerous lesions of the cervix. In their study, Vinh Hung V et al. [
In their study, Vinh Hung V et al. [
This study found that polygamy increases the risk of cervical lesions by 1.03 and contraception increases the risk by 0.92. This study found that polygamy increases the risk of cervical lesions by 1.03 and contraception increases the risk by 0.92. This discrepancy between our results and those of the literature could be related to a bias of social desirability. This discrepancy between our results and those of the literature could be related to a bias of social desirability. Indeed, marital status remains a sensitive subject especially among single women and women living in a polygamy regime. Indeed, marital status remains a sensitive subject especially among single women and women living in a polygamy regime. It may therefore be that this variable has been misjudged since erroneous information can be reported by these women.
It may therefore be that this variable has been misjudged since erroneous information can be reported by these women.
The prevalence of cervical abnormalities detected at IVA was 4.5% and those detected with IVL was 5.1%. Anatomopathically, various histological lesions have been observed for precancerous lesions, squamous cell carcinoma and adenocarcinomas. Indeed, among the women screened 96.5% had a normal cervix with benign lesions. For those with precancerous lesions confirmed by histology, our series reports 2.6% of precancerous lesions and 0.8% of squamous cell carcinomas. A low rate of 0.1% adenocarcinoma was recorded in our series. In Burkina Faso, Millogo FT et al. [
From 2010 to 2012, the annual number of women screened for cervical cancer was less than 1000 women. Between 2013 and 2015, this number almost doubled to 2053 women screened in 2015. However, the highest number of screenings was recorded in 2016 and 2017 with 7197 and 9726 women screened respectively.
The big challenge in improving screening indicators with IVA/IVL is to train providers in screening and to make screening an activity of routine consultations.
Improving screening indicators with IVA/IVL that does not require large resources is a promising avenue in Africa on which it can hope for the rate of morbidity and mortality from cervical cancer.
The authors declare no conflicts of interest regarding the publication of this paper.
Traoré, S.O., Doumbia, S., Sylla, C., Tall, S., Tegueté, I., Djibo, I., Kouyaté, F., Ongoiba, I., Traore, Y., Traore, O.M., Mounkoro, N. and Traore, M. (2020) Epidemiological and Histopathological Aspect of Precancerous and Cancerous Lesions of the Cervix in the Health District of Commune 5 of Bamako, the CHU of Point “G” and the Gabriel Touré University Hospital of Bamako in Mali. Journal of Cancer Therapy, 11, 561-570. https://doi.org/10.4236/jct.2020.119048