Influence of Demographic and Reproductive Factors on Cervical Pre-Cancer and Cancer in Bangladesh.

BACKGROUND: In Bangladesh, cervical cancer (CC) is the 2nd most common cancer with estimated 8068 new cases and 5,214 deaths every year. It is also revealed that different socio-demographic factors have association with CC. This study was performed to evaluate the colposcopy outcomes and the association of different demographic and reproductive risk factors with cervical pre-cancer and cancer. METHODS: This retrospective cross-sectional study was carried out at the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) between January 2010 and December 2016. RESULTS: A total 16147 women attended the colposcopy clinic of BSMMU with VIA positive reports. Among them, 65.73% women were referred from different VIA centers of Dhaka district. Mean age of marriage of the subjects was 16. 93 (± 1) and mean age of 1st delivery was 18.45 years (± 4.10). Almost three-fourth of them were married before 18 years and had their 1st delivery by 20 years. Colposcopy examination of the VIA positive women revealed that 36.7% had CINI, 10.6% had CINII/ III and 7.1% had carcinoma of cervix. Considering CIN as disease the Sensitivity, Specificity, PPV and NPV of colposcopy were found 99.7%, 75.3%, 70.3% and 99.8% respectively. On other hand considering CIN2+ as disease the Sensitivity, Specificity, PPV and NPV of colposcopy were found 73.8%, 92.7%, 64.4% and 95.2% respectively. Statistical analysis revealed that higher age (p=0.000), lower level of education (p=0.007), lower socioeconomic status (p=0.014), higher parity (p=0.001) had individual influence on cervical pre-cancer and cancer. CONCLUSIONS: This study indicated higher age, low level of education, lower socio-economic condition and higher parity as most important socio-demographic factors for developing cervical pre-cancer and cancer in Bangladesh.

Role of the HPV DNA test in follow-up of treated cervical intraepithelial neoplasia in Bangladesh.

BACKGROUND: Cervical cancer is a major public health problem in Bangladesh. Persistence of high risk human papillomavirus (HRHPV) influences the progression of the disease, with an important role in follow- up for cervical intraepithelial neoplasia (CIN). OBJECTIVE: To establish application of high risk HPV DNA test in the follow-up of women after treatment of CIN. MATERIALS AND METHODS: This cross-sectional and hospital based study was carried out among 145 CIN treated women during the previous six months to three years at the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University, Dhaka, between January 2011 and June 2012. Pap smear and HPV samples were collected and colposcopy was performed to find out the persistence of the disease. Cervical samples obtained were tested for HPV DNA using the Hybrid Capture II (HC-II) test. A cervical biopsy was collected whenever necessary. The results were compared to assess the efficacy of different methods during follow up such as Pap smear, HPV test and colposcopy. RESULTS: Mean age of the recruited women (n=145) was 33.6 (± 7.6), mean age of marriage was 16.8 (±2.9) and mean age of 1st delivery was 18.8 (±3.5) years. More than half had high grade CIN before treatment and 115 (79.3%) women were managed by LEEP and 20.7% were managed by cold coagulation. Among the 145 treated women, 139 were negative for HPV DNA and six of them (4.1%) were HPV positive. Sensitivity of Pap smear (40.0) and HPV DNA test (40.0) was poor, but specificity was quite satisfactory (>93.0) for all the tests. CONCLUSIONS: The high risk HPV DNA test can be an effective method of identifying residual disease. It can be added to colposcopy and this should be applied to all treated women attending for their first or second post-treatment follow-up visit at 6 months to one year, irrespective of the grade of treated CIN.

Screening for and management of high-grade cervical intraepithelial neoplasia in Bangladesh: a cross-sectional study comparing two protocols.

AIM: To evaluate the feasibility of the 'see and treat' protocol for the management of high-grade cervical intraepithelial neoplasia (CIN) at a colposcopy clinic in Bangladesh. MATERIAL AND METHODS: A cross-sectional and comparative study was carried out between two periods on 358 colposcopy-diagnosed high-grade CIN at the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU). During the first period (January 2005 to June 2008), 181 colposcopy-diagnosed high-grade CIN patients had cervical biopsy by punch biopsy forceps and histology-confirmed high-grade CIN were treated by loop electrosurgical excision procedure (LEEP). During the second period (July 2008 to December 2009), 177 colposcopy-diagnosed high-grade CIN were treated by LEEP at their first visit. RESULTS: During the first and second periods, 48 of 87 and 55 of 73 histology-proven high-grade CIN cases, respectively, received treatment. Among the study population, 37.3% women who had normal or CIN-I in histology were treated unnecessarily in the second period. The compliance of treatment improved by 20% and failure to receive treatment fell by 20%; these changes were statistically significant (P=0.006). CONCLUSION: 'See and treat' protocol is a well-accepted, feasible and useful option for management of high-grade CIN in Bangladesh. It reduces the number of visits to the clinic and failure to receive treatment.