Cervical cancer is a significant public health challenge in developing countries which bear the highest incidence and mortality rates [1]. Sub-saharan Africa in particular carries a disproportionately high burden accounting for 15.7% of all new cancer cases [2]. In Cameroon, more than 2500 new cases of cervical cancer were registered in 2022 amongst which 1852 died [3]. Several factors contribute to death in cervical cancer including local progression of the disease, metastasis and related complications like venous thromboembolism (VTE) [4]. VTE is a clinical entity that regroups deep venous thrombosis and pulmonary embolism. It is a common complication in cancer patients due to hypercoagulability status, chronic inflammation and vascular stasis, which create a favorable milieu for its development [5]. Also, venous compression due to tumor size and anticancer treatment contributes to the high incidence of VTE, especially in cervical cancer. Though the incidence of VTE in cervical cancer is well known worldwide [6][7], very few observational studies in sub-Saharan Africa have reported the factors associated with its occurrence in this specific population. Thus, the aim of our study was to assess the prevalence of VTE as well as associated factors in patients followed up for cervical cancer in Yaoundé.

During our study period, we found 326 medical files of patients with a diagnosis of cervical cancer notably 25 in the Yaoundé Central Hospital, 216 in the Yaoundé General Hospital and 85 in the Yaoundé Gynaeco obstetric and Pediatric Hospital (Figure 1). The average age of our population was 53.8 ± 12 years, with extremes of 25 and 94 years and modal age group of 55 - 95 years. The participants were mostly married, housewives with an average level of education (Table 1). The prevalence of VTE was 13.5% (27/200), amongst which 20 were deep venous thrombosis cases and 7 pulmonary embolisms. Very little number of patients (7) had the diagnosis of VTE contemporary to that of cervical cancer. Factors significantly associated with the occurrence of VTE (Table 2) were age greater than 40 years (OR = 3.84; 95% CI = 1.55, 9.33; P = 0.003), obesity (OR = 1.09; 95% CI = 1.03, 1.58; P = 0.010), and advanced cancer stage (OR = 9.31; 95% CI = 1.21, 88.0; P = 0.039). The diagnostic methods were mostly Doppler ultrasound (55.5%) for deep venous thrombosis; rarely angioCT scan (7.4%), but mostly clinical suspicion (29.7%) for pulmonary embolism according to the Wells score (Table 1). With regards to management of VTE, 48.1% of patients were place on low molecular weight heparin and the rest (51.8%) on oral anticoagulation plus compression stockings (63%). More than half (51.8%) of the patients presenting with VTE died.

Table 1.Clinical and paraclinical characteristics of participants.

Table 2.Factors associated with VTE occurrence.

Figure 1.Flow chart of participants.

The main aim of our study was to assess the prevalence and factors associated with VTE in cervical cancer patients. The prevalence of VTE in our population was 13.5%, twice greater than that published by Zhao and colleagues in 2020 in Japan as well as other authors in Asia [8]-[10]. This could be explained by the fact that the prevalence of cervical cancer is higher in sub-Saharan African countries with the diagnosis mostly made in advanced stages of the disease with more frequent complications like thromboembolic diseases [11][12]. Also, we had a larger study period from diagnosis to treatment of patients contrary to the abovementioned studies. Our participants were mostly in their 50’s with extremes of 26 and 95 years, in accordance with data found in recent literature. Indeed, this age range bears the greater proportion of active human papilloma virus infection [13] and other STDs [14]. The factors significantly associated with the occurrence of VTE in cervical cancer were age above 40 years, obesity and cancer stage. Our findings join those published by several authors on the prevalence and factors associated with the occurrence of VTE worlwide [15]-[17]. Concerning advanced age and obesity, it is well known both are associated with reduced mobility, increased coagulability and a certain degree of chronic inflammation [5]. Not surprisingly, advanced cancer stages III and IV were also associated with VTE as these stages are usually characterized by larger tumor size with important venous compression, pronounced inflammation and increased clotting factors [18]. However, in contrast with other authors [15][16][18], we did not find significant association between cancer treatment and occurrence of VTE after exclusion of confounding factors. This might be due to our smaller sample size and shorter delay between diagnosis of cervical cancer and VTE.

The retrospective nature of the study subjects it to recall bias. However, to minimize this effect, patients were called for additional information.

This study shows that VTE is highly prevalent in patients with cervical cancer in our population, mostly in women over 40 years, obese and at advanced stages of cancer.

The authors would like to thank the staff of the Gynaeco-obstetrics departments of the Yaoundé Central Hospital, the Yaoundé General Hospital and Yaoundé Gynaeco Obstetric and Pediatric Hospital for their cooperation in data collection for the study.

The datasets used for this study are available from the corresponding author upon reasonable request.

The study was approved by the Centre Regional Ethics Committee for Human Health Research (N˚634/CIERSH/DM/2024). All the participants read and signed informed consent before their inclusion in the study regarding the Helsinki declaration.

ASCO:American Society of Clinical Oncology DVT: Deep Venous Thrombosis HPV: Human Papilloma Virus LMWH: Low Molecular Weight Heparin PE: Pulmonary embolism SPSS: Statistical Package for Science STDs: Sexually Transmitted Diseases VTE: Venous thromboembolism