Malawi Medical Journal

Efficacy of HPV E6/E7 mRNA assay, HPV DNA test and cytology in detection of high grade cervical lesions and invasive cancer at a tertiary care center in India

BackgroundCervical cancer is caused by human papillomavirus (HPV) and remains a major public health issue. There are several methods for its diagnosis. Knowing their comparative usefulness may help in devising an appropriate strategy for early detection of this gynecological cancer in resource-constrained setting. AimThis study aims to evaluate the efficacy of human papillomavirus (HPV) E6/E7 mRNA assay, HPV DNA test and cytology in detection of high grade cervical lesions and invasive cervical carcinoma at a tertiary care center in India.MethodsA total of 106 women were recruited in this hospital based study and underwent molecular tests (HPV DNA test and mRNA assay), cytological test and colposcopic-guided biopsy. Histopathological diagnosis was considered as the gold standard. ResultsWe observed that 56 out of 106 participants had abnormal results in the terms of positive HPV DNA or E6/E7 mRNA with or without abnormal cytology or had histopathologically confirmed pre-malignant/malignant lesion. 47.2% (50/106) and 32% (34/106) women were positive for HPV DNA and E6/E7 mRNA respectively. 33% (35/106) women had abnormal cytology and 29.2% (31/106) had histologically confirmed CIN II and higher lesions. Sensitivity and specificity of cytology and HPV DNA for CIN III+ lesions were calculated as 92%, 90.4% versus 88% & 68% respectively. mRNA assay was found to be more sensitive (96%) and specific (93.3%) than other tests in detecting CIN II + lesions. ConclusionE6/E7 mRNA assay seems superior to HPV DNA test and cytology in detection of high grade cervical lesions and invasive carcinoma. It may be used as an alternative or adjunct to HPV DNA test or cytology for the purpose of cervical cancer screening and also be helpful in reducing the load for colposcopy.

Epidemiology of Cancers in Zambia: A significant variation in Cancer incidence and prevalence across the nation

BackgroundCancer is one of the leading causes of death worldwide. More than two-thirds of deaths due to cancers occur in low- and middle-income countries where Zambia belongs. This study, therefore, sought to assess the epidemiology of various types of cancers in Zambia.MethodsWe conducted a retrospective observational study using the Zambia National Cancer Registry (ZNCR) population based data from 2007 to 2014. Zambia Central Statistics Office (CSO) demographic data were used to determine catchment area denominator used to calculate prevalence and incidence rates of cancers. Age-adjusted rates and case fatality rates were estimated using standard methods. We used a Poisson Approximation for calculating 95% confidence intervals (CI). ResultsThe seven most cancer prevalent districts in Zambia were Luangwa, Kabwe, Lusaka, Monze, Mongu, Katete and Chipata. Cervical cancer, prostate cancer, breast cancer and Kaposi’s sarcoma were the four most prevalent cancers as well as major causes of cancer related deaths in Zambia. Age adjusted rates and 95% CI for these cancers were: cervix uteri (186.3; CI = 181.77 – 190.83), prostate (60.03; CI = 57.03 – 63.03), breast (38.08; CI = 36.0 – 40.16) and Kaposi’s sarcoma (26.18; CI = 25.14 – 27.22). CFR were: Leukaemia (38.1%); pancreatic cancer (36.3%); lung cancer (33.3%); and brain, nervous system (30.2%). The cancer population was associated with HIV with p- value of 0.000 and a Pearson correlation coefficient of 0.818.ConclusionsThe widespread distribution of cancers with high prevalence observed in the southern zone may have been perpetrated by lifestyle and sexual culture (traditional male circumcision known to prevent STIs is practiced in the northern belt) as well as geography. Intensifying cancer screening and early detection countrywide as well as changing the lifestyle and sexual culture would greatly help in the reduction of cancer cases in Zambia.

Analyzing 10-year time trends for Hysterectomy and Oophorectomy: Focus on Endometrial sampling and risk factors for Endometrial Cancer

Background Hysterectomy is a versatile and commonly employed treatment option for various benign and malignant gynecological conditions. Our study aims to take a comprehensive perspective on hysterectomy over the years using accumulated data and provide clinicians with an accurate insight into the hysterectomy operation.Material-Method This retrospective observational study was conducted on women who underwent hysterectomy at our clinic between 2012 and 2021. Comprehensive medical histories of all patients were thoroughly reviewed as the primary data. Surgical procedures were categorized and compared by year. Operation indications, preoperative endometrial sampling, and the pathology results of the final hysterectomy specimens were also examined. Risk factors were evaluated in confirmed cases of endometrial cancer and atypic endometrial hyperplasia based on pathology results. The analyses were performed using IBM SPSS 20 statistical analysis software. Results In our study,752 patients(mean age: 52±8.2) underwent various hysterectomy procedures, with total abdominal hysterectomy being the most frequent(73.3%). The primary indication was uterine leiomyomas-adenomyomas(33.5%). Endometrial sampling was performed in 57.2% of patients, showing no significant difference in reliability(p=0.143) and endometrial cancer diagnosis(p=0.334). Among 38 patients diagnosed with endometrial cancer, approximately 28.9%(11 patients) did not undergo preoperative endometrial sampling. Further examination revealed that these patients were obese, 63.6% presented with spotting-like bleeding, and most were in the postmenopausal period. Risk factors for these patients and those with atypical hyperplasia indicated statistically significant positive family history(p=0.037) and estrogen therapy history(p=0.028). Out of 536 oophorectomies, 236 were performed in women under 50.ConclusionThe study highlights the need to implement the current literature and promote minimally invasive approaches. Widespread adoption of non-hysterectomy options is essential for rate reduction. Physicians must integrate current literature, refine skills in minimally invasive methods, and advance surgical techniques to achieve an idealized approach for premalignant lesions and endometrial cancer. Presenting clinic data to personalize algorithms and treatments will strengthen the literature, enhancing the field and increasing the applicability of knowledge for personalized implementation of ideal algorithms and treatments.