May 2015 – Cervical cancer is the most common cancer among women in Malawi. Using pathological specimens from 630 Malawian, this study examines associations between various pathological findings and the presence of high-grade dysplasia.
High rates of cervical cancer among HIV-infected women at a referral hospital in Malawi
RE Kohler, J Tang, S Gopal, L Chinula, MC Hosseinipour, NG Liomba, G Chiudzu
International Journal of STD & AIDS
Full text available at PubMed Central
Abstract
Objective
Cervical cancer is the most common cancer among women in Malawi. National guidelines recommend screening women aged 30–45 years every five years; however, no specific recommendations exist for women with HIV. We aimed to assess the frequency of high-grade dysplasia (CIN 2 or CIN3) and cervical cancer among women in central Malawi and to examine associations with CIN2+ (CIN2/3 or cancer).
Methods
We extracted cervical pap smear, biopsy, loop electrosurgical excision procedure and uterine specimen reports from a hospital pathology database from November 2012 to November 2013. We used logistic regression to estimate associations with CIN2+.
Results
We reviewed specimens from 824 women; we excluded 194 with unknown HIV status, leaving 630 in the analytic sample. Twelve percent had high-grade dysplasia and 109 women (17%) had cancer. Twenty-five percent of high-grade dysplasia cases and 35% of cancers occurred among women outside recommended screening ages. The odds of having CIN2+ were 6.55 times (95% CI 4.44–9.67) greater for HIV+ women.
Conclusions
High-grade dysplasia and cervical cancer are very common among Malawian women, especially HIV+ women. HIV infection was strongly associated with CIN2+. Expanding screening to women not covered by current guidelines could avert a substantial proportion of cervical cancer cases in Malawi.