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. 2023 Sep:9:e2300139.
doi: 10.1200/GO.23.00139.

Expanding Cervical Cancer Screening in Mozambique: Challenges Associated With Diagnosing and Treating Cervical Cancer

Samantha Batman  1 , Ricardina Rangeiro  2 , Eliane Monteiro  3 , Dercia Changule  2 , Siro Daud  2 , Magda Ribeiro  2 , Edgar Tsambe  2 , Celso Bila  2 , Nafissa Osman  4 , Carla Carrilho  4 , Andrea Neves  5 , Hira Atif  2 , Celda De Jesus  2 , Arlete Mariano  2 , Renato Moretti-Marques  6 , Marcelo Vieira  7 , Georgia Fontes-Cintra  8 , Andre Lopes  9 , Jean Claude Batware  10 , Elvira Luis  2 , Surbhi Grover  11 , Ellen Baker  1 , Bryan Fellman  1 , Jane Montealegre  1 , Philip E Castle  12 , Jose Jeronimo  12 , Elizabeth Chiao  1 , Cesaltina Lorenzoni  2 , Kathleen Schmeler  1 , Mila P Salcedo  1
Affiliations

Expanding Cervical Cancer Screening in Mozambique: Challenges Associated With Diagnosing and Treating Cervical Cancer

Samantha Batman et al. JCO Glob Oncol. 2023 Sep.

Abstract

Purpose: Mozambique has one of the highest burdens of cervical cancer globally. Treatment options are few as most women present with advanced disease, and there are limited trained health professionals and health care resources. The objective of this study was to describe the outcomes of women diagnosed with invasive cancer as part of the Mozambican women undergoing cervical cancer screening with human papillomavirus (HPV) testing in conjunction with family planning services (MULHER) study.

Materials and methods: Women age 30-49 years were prospectively enrolled in the MULHER study and offered screening with primary HPV testing followed by treatment of screen-positive women with thermal ablation or excision as appropriate. Women with cervical examination findings suspicious for cancer were referred to one of the three gynecologic oncologists in the country.

Results: Between January 2020 and January 2023, 9,014 women underwent cervical cancer screening and 30 women were diagnosed with cervical cancer. In this cohort, four patients (13.3%) had early-stage disease, 18 (60.0%) had locally advanced disease, one (3.3%) had distant metastatic disease, and seven (23.3%) did not have staging information available. Five patients (16.6%) died without receiving oncologic treatment, and seven patients (23.3%) are still awaiting treatment. Of the remaining 18 patients, three (17.6%) underwent surgery and four (23.5%) received radiotherapy. Eleven (36.7%) patients received only chemotherapy.

Conclusion: As cervical screening programs are implemented in low-resource settings, there will likely be an increase in the number of women diagnosed with invasive cervical cancer. Our results in Mozambique demonstrate the need to increase access to advanced surgery, radiation, and palliative care services.

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Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/go/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Figures

FIG 1
FIG 1
Oncologic treatment for 30 patients diagnosed with invasive cervical cancer. aSix patients had a treatment plan of neoadjuvant chemotherapy followed by RT; however, two are still awaiting RT. RT, radiotherapy.
FIG 2
FIG 2
Patient treatment flow from time of biopsy to time of first treatment. CT, computed tomography; MRI, magnetic resonance imaging.
See this image and copyright information in PMC

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