The Kenya cancer research and control stakeholder program: Evaluating a bilateral partnership to strengthen national cancer efforts.

Background: In response to a growing cancer burden and need for improved coordination among stakeholders in Kenya, the US National Cancer Institute and the Kenya Ministry of Health collaboratively hosted a stakeholder meeting in 2014 which identified four priority areas of need (research capacity building, pathology and cancer registries, cancer awareness and education, and health system strengthening) and developed corresponding action plans. Methods: Surveys were conducted with participants to collect input on the progress and impact of the 2014 stakeholder meeting. Findings: Of 69 eligible participants, 45 responded from academia, healthcare institutions, civil society, government, and international agencies. Of the four technical focus areas, three have continued to conduct working group meetings and two have conducted in-person meetings to review and update their respective action plans. Accomplishments linked to or enhanced by t meeting include: Kenyan and international support for expansion of population-based cancer registries, increased availability of prioritized diagnostic tests in selected regional referral hospitals, a greater focus on development of a national cancer research agenda, strategic planning for a community education strategy for cancer awareness, and improved coordination of partners through in-country technical assistance. Interpretation: The Stakeholder Program has successfully united individuals and organizations to improve cancer control planning in Kenya, and has enhanced existing efforts and programs across the country. This model of partners working in parallel on prioritized track activities has supported development of long term coordination of cancer research and control activities sustainable by the Kenyan government and Kenyan institutions.

CRYOTHERAPY FOLLOWING VISUAL INSPECTION WITH ACETIC ACID AND LUGOL'S IODINE (VIA/VILI) IN KHWISERO, WESTERN KENYA: LESSON FROM THE FIELD AFFECTING POLICY AND PRACTICE.

BACKGROUND: Cervical cancer can be prevented and mortality/morbidity reduced by early detection and referral. Developing countries are likely to benefit from more cost effective methods of screening and treatment. Visual inspection with acetic acid and Lugol's iodine (VIA/VILI) offers a see and treat solution thus an affordable and efficient way to identify pre-malignant lesions. Immediate treatment with cryotherapy can be offered if pre-malignant lesions are found on visual inspection. Cryotherapyis a simple procedure that is curative for dysplasia; it is likely to benefit cervical dysplasia cases picked early in resource poor settings, however there are several factors that hinder patients' access to this noble technique. OBJECTIVE: Determine hindrances to cryotherapy for patients following positive results of VIA/VILI after referral. DESIGN: Cross sectional Study SETTING: Khwisero, Western Kenya. SUBJECTS: Women attending a medical camp, willing to get screened for cervical cancer. RESULTS: One hundred and nine patients were screened; seventy three (66.97%) were negative for VIA/VILI, twenty one (19.26%) were positive and referred for cryotherapy. Reasons for lack of follow up were financial constraints, lack of medical personnel at referral centres and poor access to the referral facilities.19.26% of women identified with positive lesions required intervention. No patient received cryotherapy following referral. CONCLUSION: There is urgent need for availability of cryotherapy machines and training of personnel who can perform cryotherapy at the primary care level. Regional studies on knowledge attitudes and practices about VIA/VILI and cryotherapy are required to provide reasons for the poor uptake of this procedure.

Fine needle aspiration cytology of thyroid nodules at Kenyatta National Hospital, Nairobi.

OBJECTIVE: To determine the pattern of thyroidal nodules diagnosed by (FNA) cytology. DESIGN: A cross-sectional study. SETTING: Kenyatta National Hospital (KNH)--a University of Nairobi affiliated hospital. SUBJECTS: Forty two patients seen at FNA clinic at KNH between June and August 2001. RESULTS: The female to male ratio was 7:1, with the majority in the age group 31-50 years. Overall 88.1% patients had benign FNA cytologic diagnostic results, 2.4% had a malignant, and a suspicious result respectively and 7.1% were non-diagnostic. Cytological results were as follows, nodular goiter comprised 83.3%, non-diagnostic samples 7.1%, papillary carcinoma 2.4%, atypia 2.4%, thyroglossal cyst 2.4%, and thyroiditis 2.4%. CONCLUSION: The findings are comparable in terms of sex, age and FNA cytologic diagnostic results to other studies. FNA cytology offered clinicians the possibility of early diagnosis of benign (>70%) and malignant (<5%) lesions. The test was an out-patient procedure, safe, time saving, cost effective and helped determine the course of therapy in the management of patients with thyroid nodules.

The effects of HIV-1 Tat protein on cell cycle during cervical carcinogenesis.

The role of HPV in the carcinogenesis of intraepithelial and invasive anogenital lesions is currently well established. E6 and E7 oncoproteins of high-risk HPV genotypes are known to inactivate p53 and pRb pathways. Several studies have described an increased prevalence and recurrence of both cervical HPV infection and invasive cervical cancer among HIV-1 positive women compared to HIV-1 negative cases. For these reasons, cervical cancer is considered an AIDS-defining neoplasm. Unlike other AIDS-associated neoplasms, the occurrence of cervical cancer is independent of immune suppression. HIV-1 infection in patients with high grade precancerous lesions and invasive cervical cancers results in a therapy refractory and more aggressive disease phenotype, which is not yet well understood at the molecular level. An upregulation of HPV E6 and E7 gene expressions by HIV-1 proteins such as Tat has been documented by some authors. However, the role of HIV-1 in cervical carcinomas is still unclear. It is already known that HIV-1 Tat protein is able to influence cell cycle progression. Altogether, these facts led us to investigate the effects of Tat on the expression of cell cycle regulator genes. After transfection of HeLa cells with Tat, we analyzed the expression of cell cycle regulators from these cells by IHC and Real-time PCR. A significant reduction in the expression of cell cycle inhibitors of transcription and an increase in the levels of proliferation markers were observed. These results suggest that HIV-1 may enhance cervical carcinogenesis by promoting cell cycle progression. We also found that this HIV-1 Tat-induced cell proliferation was not dependent on the E2F family of transcription factors, and therefore postulate that Sp factors may be involved.

Correlation between cytology and thyroid function test.

BACKGROUND: Thyroid dysfunction can be evaluated by measuring serum thyroid stimulating hormone (TSH), total tri-iodothyronine (T3) and total thyroxine (T4) which will establish euthyroidism, hyperthyroidism and hypothyroidism. Fine needle aspiration (FNA) is the diagnostic test of choice in determining whether a nodule is benign or malignant. OBJECTIVE: To correlate hormonal levels to FNA cytologic findings. DESIGN: A cross-sectional study. SETTING: Kenyatta National Hospital (KNH). RESULTS: Forty two patients had their thyroid profiles done and the results were correlated with FNA diagnosis. Majority of patients had nodular goiter (83.3%), of which 47.6% had euthyroidism, 16.7% had biochemical euthyroidism, 11.9% had hyperthyroidism, 4.8% had sub-clinical hyperthyroidism and 2.4% had sub-clinical hypothyroidism. Three patients (7.1%) with FNA diagnosis of non-diagnostic sample had euthyroidism while 2.4% each with papillary carcinoma, thyroglossal cyst, and atypia, had a hormonal profile of euthyroidism. There was no significant statistical difference (p > 0.05) of the mean levels of T4 (0.406), T3 (0.311), and TSH (0.90), between and within the various groups of FNA cytological diagnoses. CONCLUSION: The study showed that there was no correlation between T4, T3, and TSH measurements and FNA cytological diagnoses.

Comparison of pap smear, visual inspection with acetic acid, human papillomavirus DNA-PCR testing and cervicography.

OBJECTIVE: To assess the test qualities of four screening methods to detect cervical intra-epithelial neoplasia in an urban African setting. METHOD: Six hundred fifty-three women, attending a family planning clinic in Nairobi (Kenya), underwent four concurrent screening methods: pap smear, visual inspection with acetic acid (VIA), PCR for high risk human papillomavirus (HR HPV) and cervicography. The presence of cervical intra-epithelial neoplasia (CIN) was verified by colposcopy or biopsy. RESULT: Sensitivity (for CIN2 or higher) and specificity (to exclude any CIN or cancer) were 83.3% (95% CI [73.6, 93.0]) and 94.6% (95% CI [92.6, 96.5]), respectively, for pap smear; 73.3% (95% CI [61.8, 84.9]) and 80.0% (95% CI [76.6, 83.4]) for VIA; 94.4% (95% CI [84.6, 98.8]) and 73.9% (95% CI [69.7, 78.2]) for HR HPV; and 72.3% (95% CI [59.1, 85.6]) and 93.2% (95% CI [90.8, 95.7]) for cervicography. CONCLUSION: The pap smear had the highest specificity (94.6%) and HPV testing the highest sensitivity (94.4%). The visual methods, VIA and cervicography, were similar and showed an accuracy in between the former two tests.

Risk factors for human papillomavirus and cervical precancerous lesions, and the role of concurrent HIV-1 infection.

OBJECTIVES: To identify risk factors for human papillomavirus (HPV) infection and squamous intraepithelial lesions (SIL) of the cervix, and to measure the impact of concurrent HIV-1 infection. METHODS: Women were studied at a family planning clinic in Nairobi, Kenya. Demographic and historical information was obtained using a semi-structured questionnaire and specimens were collected for sexually transmitted diseases (STDs), HPV, cervical cytology, and HIV-1 testing. RESULTS: HPV was detected in 87 of 513 women (17%), including 81 (93%) oncogenic types (16, 18, 31, 33 and others) and six (7%) non-oncogenic types (6 and 11). HIV-1 prevalence was 10%. HPV detection was associated with HIV-1 infection [adjusted odds ratio (aOR) 3.9, 95% confidence interval (CI), 2.0-7.7], sexual behavior indicators including the number of sex partners and inflammatory STDs, as well as the number of pregnancies (0 or 1 vs. > or = 3, aOR 0.4; 95% CI, 0.2-0.9). SIL was detected in 61 women (11.9%), including 28 (46%) with low-grade lesions (LSIL) and 33 (54%) with high-grade lesions (HSIL). HPV infection was strongly associated with HSIL (OR 14.9; 95% CI, 6.8-32.8). In a multivariate model predictors of HSIL included HIV-1 serpositivity (aOR 4.8; 95% CI, 1.8-12.4), the number of lifetime sex partners (0-1 vs. > or = 4; aOR 3.8; 95% CI, 1.1-13.5), and older age (< 26 vs. > 30; OR 3.9; 95% CI, 1.1-13.6). An analysis stratified by HIV-1 showed a stronger association between HPV and HSIL in HIV-1 negative women (OR 17.0; 95% CI, 6.4-46.3) then in HIV-1 positive women (OR 4.5; 95% CI, 0.8-27.4). CONCLUSION: Our results indicate that HSIL and even invasive cancer are highly prevalent in this setting of women on reproductive age considered to be at low risk for STDs, suggesting that routine Pap smear screening may save lives.

The supermarket for women's reproductive health: the burden of genital infections in a family planning clinic in Nairobi, Kenya.

OBJECTIVES: To study the burden of disease of reproductive tract infections (RTIs) and cervical dysplasia in women attending a family planning clinic in Nairobi, Kenya, and to assess the acceptability of integrating reproductive healthcare services into existing family planning facilities. METHODS: In a family planning clinic in Nairobi, Kenya, 520 women were enrolled in a study on RTI and cervical dysplasia. RESULTS: RTI pathogens were detected in over 20% of women, the majority being asymptomatic. HIV-1 testing was positive in 10.2%. The diagnosis of cervical dysplasia was made on 12% of the cytology smears (mild in 5.8%, moderate in 3.5%, severe in 1.2%), and 1.5% had invasive cervical cancer. The intervention of case detection of RTI and Papanicolaou smear taking was well received by clients and considered feasible by the staff. CONCLUSIONS: Early detection and treatment of potentially curable cervical lesions and RTI provide a unique opportunity to improve women's health. In Kenya, where the current contraceptive prevalence rate is 33%, family planning clinics are excellent sites to introduce health interventions.

Quantitative assessment of oestrogen and progesterone receptors on fine-needle aspirates and cryostat sections of breast carcinomas: how does this compare with biochemical assays?

In this study monoclonal antibodies to oestrogen receptors in the ER-ICA kit (Abbott) and to progesterone receptors (Biogenex) were used to determine the presence of those receptors in fine needle aspirates and cryostat sections. The degree of positivity is semi-quantitated and the results compared to biochemical assays (Dextran-Coated Charcoal Method) performed on the same specimens. Out of 14 cases that were positive on the biochemical assay, 11 (77%) were positive on ER-ICA performed on the FNA material, and there was a 100% agreement on the cryostat sections (11/11). PR-ICA on the cytospin smears and cryostat sections agreed in 63% and 90% respectively.

Role of fine-needle aspiration biopsy in the diagnosis of breast lumps at the Kenyatta National Hospital.

During 1990-1991, all patients seen at the surgical out-patient clinic at the Kenyatta National Hospital (KNH) with breast lumps had a fine-needle aspiration biopsy for diagnosis prior to open biopsy. Out of 105 that had corresponding surgical biopsies, 82 aspirates were considered satisfactory. Of these, the correct diagnosis was made in 59 (71%), another 12 (21%) were called benign but the correct histologic diagnosis was not made, 7 (8.5%) were correctly called negatives. The diagnostic accuracy of this method in differentiating benign from malignant was 95% in this study.