A 10‑year retrospective study on a population‑based cervical cancer screening programme in Nigeria

BACKGROUND: Human papillomavirus (HPV) is the main cause of cervical cancer, and about 80% of women will be infected at least once in their life time. Cervical cancer is the fourth most common cancer in women and the second highest cause of cancer deaths. Persistent HPV infection progresses to cancer over several years, and during this period, pre‑cancerous lesions can be detected by screening. Visual inspection under acetic acid (VIA) is an easy safe, affordable and effective test in cervical cancer screening in resource‑poor countries like Nigeria.

AIM: The aim of the study is to determine the proportion of women with VIA‑positive findings and the associated factors among those screened for cervical cancer in a screening programme between 2008 and 2017.

METHODS: This is a retrospective study using the database of women who presented for breast and cervical cancer screening by the Akwa‑Ibom State branch of the Medical Women’s Association of Nigeria between 2008 and 2017. A structured questionnaire was used to abstract data from the records of the attendees at the cancer screening sessions in the years indicated. There are many factors that discourage women from screening for cervical cancer. Some authors cite embarrassment, low perception of cancer risk, physician gender preference, lack of spousal support; high cost; belief that cancer is a death sentence, and societal discrimination.

RESULTS: A total of 2203 women were screened for cervical cancer between 2008 and 2017. The mean age was 40.2 years. Only 284 (12.9%) women had been previously screened for cervical cancer, and majority of these were screened over 2 years prior. The mean age at sexual debut was 19.4 years, those who had used contraceptive pills in the past were 639 (29.0%) while 124 (5.6%) used it currently. 
Forty‑four (2.0%) of the screened women had VIA‑positive lesions, and 1.6% had lesions suspicious for cancer. On bivariate analysis, age, marital status, age at sexual debut, number of pregnancies and previous use of oral contraceptive pills were significantly associated with findings on VIA.

CONCLUSION: This study found VIA‑positive findings in a small proportion of the women screened. A follow‑up of the definitive diagnosis and treatment of the VIA‑positive women is strongly recommended. Efforts should be made to provide early comprehensive sex education and screening to detect early lesions to reduce morbidity and mortality from cervical cancer in the population.