Treatment and outcomes of late stage vulva cancer at Pretoria Academic Hospital Complex, South Africa

Vulva cancer has been regarded as a rare disease in elderly women, diagnosed at a mean age of 70 years. Over the past few decades however, vulva cancer has shown an increasing incidence with a concurrent decreasing mean age. The increased incidence of human papilloma virus (HPV) is believed to be linked with the increasing incidence in younger women.https://journals.co.za/content/journal/medogpm2020Obstetrics and Gynaecolog

Challenges in preventative care and research in primary healthcare facilities : information obtained during implementation of a cervical cancer screening project in the Tshwane Health District

OBJECTIVES: The aim was to identify challenges to conducting research and obstacles to successful cervical cancer screening in public sector primary healthcare clinics (PHCs). DESIGN: Qualitative research was conducted, using semi-structured interviews. SETTING AND SUBJECTS: Study staff and healthcare workers involved in the implementation of a large screening study conducted in existing primary healthcare facilities were interviewed during the study period. OUTCOME MEASURES: The outcome measure was qualitative data on problems and obstacles to research and cervical cancer screening in public health facilities. RESULTS: Twenty-one participants were interviewed at intervals over three years. It was found that clinical research could only be conducted in PHC facilities if no additional burden was placed on the staff or facilities. Preventative care was not found to be part of the focus of the clinics, which rather concentrated on disease. The need for gynaecological examinations was identified as an important obstacle to screening at PHC clinics. Self-sampling was widely accepted, as was cervical sampling for human papillomavirus. Reporting of screening results to patients presented a huge challenge to PHC facilities. Ineffective communication of the results was identified as another major obstacle to effective screening. CONCLUSION: Future cervical cancer screening methods should include sampling, without the need for an intimate examination. Finding new ways of calling women in for structured screening at regular intervals and reporting the results to them requires urgent attention.http://www.sajgo.co.za/index.php/sajgoam201

Human papillomavirus DNA testing on self-collected vaginal tampon samples as a cervical cancer screening test in a Gauteng population

BACKGROUND: There is a need to simplify cervical cancer screening to reach more women. Tampon-collected specimens can be tested using molecular methods, but this type of self-screening has not been properly evaluated as a screening method in South Africa before. The objective of this study was to evaluate human papillomavirus (HPV) DNA testing of self-collected tampons as a screening method in an urban and peri-urban population in Gauteng by comparing the results with the current standard of conventional cytology. In addition, HPV prevalence, type, distribution and incidence of cytological abnormalities in this population are described. METHOD: Seven hundred and twenty women attending public healthcare facilities in and around Tshwane, Gauteng province, were invited to participate. The women collected a tampon sample for molecular testing, and were then screened by healthcare workers collecting a conventional cervical cytology smear. HPV testing was undertaken using the Linear Array® HPV Genotyping Test (Roche Molecular Systems). RESULTS: Data for analysis were available for 631 women. Three hundred and fifty-four (58%) were positive for highrisk HPV, while (15.4%) had an abnormal cytology result. Women aged 30-39 years had the highest prevalence of both high-risk HPV (75%) and abnormal cytology (22%). Infection with multiple types was common. Higherrisk viruses were not over-represented in, and no dramatic decrease in HPV prevalence was observed in, older women. Cytological abnormalities were detected in only 3.74% of women who tested negative for high-risk HPV, but were found in 24.2% of high-risk HPV positive women. CONCLUSION: HPV testing on self-collected tampon samples was feasible, highly sensitive and demonstrated a high negative predictive value for current cytological abnormalities in this population.Cancer Association of South Africahttp://www.sajgo.co.za/index.php/sajgoam201