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Introduction: Though
highly preventable, cancer of the cervix uteri (CCU) is the second most
frequent female cancer in Sub-Saharan Africa. Major underlying causes include:
lack of skilled health professionals and inefficient/inexistent national
control programs.
Organizers
and objectives: To (further) train health staff and deliberate on
challenges and constraints in prevention and treatment of CCU in resource-poor
sub-Saharan African settings. This meeting was held under the auspices of the
University of Dschang (West - Cameroon) and collaborating organizations were:
faculties of medicine of the Universities of Dschang, Geneva, Yaounde I and the
Cameroonian network of alumni physicians from Swiss Universities.
Participants: 193
delegates (students, nurses, trainees and residents, physicians, biologists,
laboratory scientists, anthropologists, public health specialists,
representatives of pharmaceutical industries) from Cameroon, France, Ivory
Coast, Switzerland, Gabon, Congo-Brazzaville and the United States of America
were present.
Contents: The
first part consisted of 25 master-classes on the fundamentals of CCU
(epidemiology and control strategy, screening and management of pre-cancerous
lesions); in the second part, 37 original researches summarizing field
experiences and innovations in prevention and management of CCU were discussed.
Conclusion
and recommendations: A national working group should be set up to
harmonize clinical practices in preventing and handling CCU. Besides the only
radiation therapy unit in the country should be re-started with support of some
international agencies like the International Agency for Atomic Energy.
Keywords:
Cervix uteri cancer, Sub-Saharan Africa, Prevention, Screening,
Management
INTRODUCTION
The 9th
edition of the annual congress on Cancer of the Cervix uteri (CCU) in
sub-Saharan Africa (SSA) took place from the 29th to the 30th of March 2018.
Considering that CCU is the second most prevalent and deadly cancer among
sub-Saharan African women especially in rural areas, the organizing committee
located the event at the University of Dschang (West-Cameroon) which is
dedicated to rural development [1,2]. The meeting had two main goals: to
(further) train health workers and to share field experiences among teams in
other to optimize cervical cancer control programs in SSA. Under the patronage
of the Vice-Chancellor of the University of Dschang, the following institutions
co-organized the congress: faculties of medicine
1.
Cervical cancer epidemiology and prevention strategy
In this session, the picture of CCU in SSA was
presented and different preventive strategies were discussed under the
chairmanship of the Director of the CIESPAC (Centre Inter-Etats de Santé
Publique d’Afrique Centrale). He emphasized that SSA is the continent with the
highest prevalence and morbi-mortality of CCU. Visual methods (visual
inspection with acetic acid and lugol’s iodine) in a screen and treat approach
are the most appropriate technique that could only be scaled up if the
community is fully involved. The 20 year collaboration between the Geneva
University Hospitals and some university teaching hospitals in Cameroon for the
control of CCU was reviewed and assessed by delegates to be used as a model.
The governmental project to introduce free of charge Human Papilloma Virus
(HPV) vaccination in Cameroon was not presented as scheduled.
2.
Basics on cervical cancer
The first part of this session was dedicated to
cervical epidemiology, natural history of HPV infection the pathway to CCU. The
value of the so-called “HPV-negative CCU” was explored. Following those
presentations, demonstrations of visual methods (naked eye and colposcope) of
diagnosis of pre-cancerous lesions took place. Participants were also
introduced to an online self-training tool to visual diagnostic methods. During
two presentations dedicated to digital health and innovations, the potential
impact of digital cervicography using smartphones programs and a mobile
colposcope were discussed. Current techniques for the management of precancerous
lesions of the cervix were reviewed and explained to delegates.
3.
Cervical cancer control programs in sub-Saharan African
settings
Several ongoing or planned programs were presented
and/or assessed. Delegates from the Cameroon Baptist Convention health services
shared their experience in screening CCU in rural Cameroon for more than a
decade. Participants thoroughly discussed their following activities:
fee-for-service in cervical cancer screening, screening CCU among sex workers
and co-testing with
care HPV DNA testing - digital cervicography. A clinical trial led
by the Geneva University Hospitals and just launched in west-Cameroon was presented;
its aim is to assess the efficacy of HPV-test followed by visual methods to
detect pre-cancers of the uterine cervix. The ongoing project of setting up a
national cancer control center in Cameroon under the leadership of the
presidency of the republic with technical assistance from the Sapienza University of Rome was
summarized and its shortcomings were discussed [2]. Initiation of cervical
cancer screening in two primary care health facilities (one state-owned: Mbouda
District Hospital and one faith-based: Mankon (Bamenda) Presbyterian health
Centre) were assessed by experts. The
school of public health of central Africa (CIESPAC) presented the project to
implement operational cervical cancer screening units in all the seven member
states. Delegates from the Evangelic University of Bandjoun (West Cameroon)
emphasized the need of training enough pathology technicians for any nationwide
cervical cancer control program to be effective. The French National Agency for
Research on HIV/AIDS and viral hepatitis (ARNS) presented the mid-term report
of the AIMA-CC project focusing on cervical cancer control in HIV-positive women
in Cameroon, Ivory Coast and Burkina Faso.
4.
Multidisciplinary management of invasive cervical cancer
The principles of surgery and chemotherapy for
invasive CCU were explained to participants. The constraints and challenges for
those therapeutic modalities in resource-poor settings in SSA were debated. The head of radiotherapy unit of
the Douala General Hospital summarized their experience in managing invasive CCU before
the breakdown of their unique machinery in Central Africa. The opportunity of starting a high-tech
radio-oncology unit in Douala with the financial and technical support of the
International Agency for Atomic Energy was described by the Head of the
corresponding department of the Geneva University Hospitals. The need to
promote palliative care for women with advanced/terminal CCU was also
emphasized given that this domain is often neglected. Therapeutic modalities
not yet available in SSA were not discussed (personalized medicine and
immunotherapy).
5.
Free communications
Besides masterclasses, the following free
communications were given.
CONCLUSION
The final
recommendations were: 1) To set up national working groups to formulate
guidelines for screening and management of CCU; 2) To tackle the long lasting
breakdown of the radiotherapy machinery at the Douala Regional Hospital. Other
sub-Saharan African countries could learn from the partnership model between
Cameroon and Geneva in setting up their national cervical cancer control
programs.
1.
World Health Organization (2018) GLOBOCAN 2018: Cancer
fact sheets. Available at: http://www.gco.iarc.fr/today/fact-sheets-cancers
2.
Fouogue JT, Sando Z, Fouelifack FY, Tebeu PM, Kamgaing
JT, et al. (2016) Report of the 7th International Workshop on
Colposcopy, Screening and Prevention of Cervical Cancer, Douala (Cameroon),
March 30-31 and April 1st, 2016. Int J Reprod Contracept Obstet
Gynecol 5: 3269-3274.
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