Investigator
University Of Botswana
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.
Impact of the COVID-19 Pandemic on Cervical Cancer Treatment Delays in Botswana
PURPOSE Although the majority of cervical cancer cases are in sub-Saharan Africa, little is known regarding how the COVID-19 pandemic affected cancer care in this context. Drawing from robust longitudinal data, this study aimed to assess cervical cancer treatment patterns in Botswana before and during the pandemic. METHODS Longitudinal clinical and patient-reported data from a cohort of over 1,000 patients seen at a gynecologic oncology multidisciplinary team clinic in Botswana were used to evaluate treatment initiation patterns before (April 2018-December 2019) and during (April 2020-December 2021) the pandemic. The primary outcome was timeliness of treatment, defined as the number of days between the patient's first clinic visit and treatment initiation date, and categorized as timely (≤30 days), delayed (>30 days), or no treatment. The primary exposure was time of visit (pre–COVID-19 v COVID-19), defined by the month of the clinic visit. RESULTS Of the 559 patients with cervical cancer diagnosed during the study period, 336 were seen pre–COVID-19, and 223 were seen during the COVID-19 period. During the pandemic, a higher proportion of patients experienced treatment delays (66.4%) or received no treatment (24.2%), compared with the pre–COVID-19 period (35.7% and 9.8%, respectively; P < .001). Multivariable regression models indicated that patients seen during the pandemic were 10 times more likely to experience treatment delays (adjusted odds ratio [aOR], 10.01 [95% CI, 5.69 to 17.62]) and 14 times more likely to receive no treatment (aOR, 14.16 [95% CI, 7.14 to 28.10]). CONCLUSION The pandemic exacerbated treatment delays for patients with cervical cancer in Botswana. There is a need for evidence-based strategies to address these treatment delays, considering the disproportionate burden of disease and persistent disparities in access to care in Botswana and other low- and middle-income countries.
Benchmarking of the Cervical Cancer Care Cascade and Survival Outcomes After Radiation Treatment in a Low- and Middle-Income Country Setting
Delays in care for patients with cervical cancer in Botswana can be benchmarked using a multidisciplinary clinic model.
