Prevalence, characteristics, and outcomes of HIV-positive women diagnosed with invasive cancer of the cervix in Kenya

Objective: To determine the prevalence of invasive cervical cancer (ICC) and assess access to, and outcomes of, treatment for ICC among HIV-infected women in Kisumu, Kenya. Methods: We performed a retrospective chart review to identify women diagnosed with ICC between October 2007 and June 2012, and to examine the impact of a change in the referral protocol. Prior to June 2009, all women with ICC were referred to a regional hospital. After this date, women with stage IA1 disease were offered treatment with loop electrosurgical excision procedure (LEEP) in-clinic. Results: Of 4308 women screened, 58 (1.3%) were diagnosed with ICC. The mean age at diagnosis was 34 years (range, 22-50 years). Fifty-four (93.1%) women had stage IA1 disease, of whom 36(66.7%) underwent LEEP, 7 (12.9%) had a total abdominal hysterectomy, and 11(20.4%) had unknown or no treatment At 6, 12, and 24 months after LEEP, 8.0% (2/25), 25.0% (6/24), and 41.2% (7/17) of women had a recurrence of cervical intraepithelial neoplasia 2 or worse, respectively. Conclusion: Most HIV-positive women diagnosed with ICC through screening had early-stage disease. The introduction of LEEP in-clinic increased access to treatment: however, recurrence was high, indicating the need for continued surveillance. (C) 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.