Jessica George

Outcomes of Loop Electrosurgical Excision Procedures Performed for Severe Cervical Dysplasia in Botswana

PURPOSE In Botswana, a see-and-treat approach to cervical cancer screening is taken. Our objective was to determine the number of loop electrosurgical excision procedures (LEEPs) performed for cervical intraepithelial neoplasia (CIN) 2/3 in Botswana, and follow-up rates and outcomes, among women with positive cervical margins. METHODS Data (patient age, HIV status, margin status, follow-up, and recurrence) from women who underwent LEEP with histologically confirmed CIN 2/3 between January 2014 and December 2015 were analyzed retrospectively. Histopathologic reports were reviewed at a central laboratory in Gaborone, Botswana. Follow-up and recurrence rates were summarized descriptively and compared according to HIV and margin statuses using chi-squared tests. RESULTS In total, 779 women (median age, 39.2 years) underwent LEEP showing CIN2/3; 638 (81.9%) women had CIN3 and 390 (50.1%) had positive LEEP margins (ectocervical, 186 [47.7%]; endocervical [including with ectocervical], 204 [52.4%]). Margin positivity was not associated with HIV status. Of women with positive endocervical margins followed at ≤1 and >1 year, 9.6% and 48.3%, respectively, had persistent CIN2/3 on repeat LEEP. Forty percent (90 of 204) of women with positive endocervical margins had no re-excision documented. CONCLUSION Most women who underwent LEEP had CIN3 and positive margins. Almost half with positive margins followed at >1 year after initial LEEP had CIN2/3 recurrence warranting further treatment; two thirds were not followed. Resources are needed to improve post-LEEP follow-up for women with margin positivity who require additional ablative/excisional procedures to reduce the cervical cancer burden in Botswana.

Assessing the impact of multidisciplinary team gynecological oncology care in Botswana: A potential model for low‐ and middle‐income countries

AbstractBackgroundIn Botswana, a multidisciplinary team (MDT) clinic was established in 2015 to streamline care for all patients with gynecological malignancies including cervical cancer, Botswana’s leading cause of cancer mortality.MethodsPatients presenting at the MDT clinic in Gaborone, Botswana, were prospectively enrolled. Temporal trends in stage and treatment distributions were assessed using the Cochran‐Armitage χ2 test. Overall survival was estimated using the Kaplan‐Meier method.ResultsBetween 2015 and 2023, 2345 patients were enrolled. Mean age was 52.0 years (SD 13.1 years) and 62.9% (n = 1474) were living with HIV. Annual volume increased 4‐fold by 2023. Most patients had cervical cancer (74.3%), followed by vulvar (11.9%), endometrial (8.8%), ovarian (3.6%), and vaginal (1.3%) cancers. Stage distribution was: Stage I 19.2%, Stage II 23.9%, Stage III 31.3%, and Stage IV 9.4%. Trends toward increased diagnosis of Stage I disease (p < .0018) and decreased diagnosis of Stage II disease (p = .002) were observed in cervical cancer patients over the years of MDT consultation. Two‐year overall survival for patients with cervical cancer treated between 2015 and 2019 was 67.1% and increased to 75.2% between 2020 and 2024 (p = .002), potentially driven by increased survival of those with Stage II disease (75.7% vs. 84.8%, p = .025). This coincided with an increase in patients with cervical cancer receiving primary surgery (p < .001) and a decrease in those receiving radiotherapy with concurrent chemotherapy (p < .001) and radiotherapy alone (p < .001).DiscussionGynecological cancer outcomes after MDT clinic establishment significantly improved over time. Although ongoing efforts to optimize care are still needed, the success of the MDT clinic in Botswana can serve as a model for coordinated multidisciplinary care in other low‐resource settings.