Prevalence and Risk Factors for Cancer of the Uterine Cervix Among Women Living in Kinshasa, the Democratic Republic of the Congo: a Cross-sectional Study

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Background: Cancer of the uterine cervix is the leading cause of cancer-related death among women in Sub-Saharan Africa, but information from the Democratic Republic of the Congo (DRC) is scarce. The study objectives were to: 1/ assess prevalence of (pre)cancerous cervical lesions in adult women in Kinshasa, 2/ identify associated socio-demographic and behavioural factors and 3/ describe human papillomavirus (HPV) types in cervical lesions. Methods: A cross-sectional study was conducted in Kinshasa. Between 2006 and 2013, four groups of women were recruited. The first two groups were included at HIV screening centres. Group 1 consisted of HIV-positive and group 2 of HIV-negative women. Group 3 was included in large hospitals and group 4 in primary health centres. Pap smears were studied by monolayer technique (Bethesda classification). Low- or high-grade squamous intraepithelial lesions or carcinoma were classified as LSIL+. HPV types were determined by INNO-LiPA®. Bivariate and multivariable analyses (logistic regression and generalised estimating equations (GEE)) were used to assess associations between explanatory variables and LSIL+. Results: LSIL+ lesions were found in 76 out of 1018 participants. The prevalence was 31.3 % in group 1 (n = 131 HIV-positive women), 3.9 % in group 2 (n = 128 HIV-negative women), 3.9 % in group 3 (n = 539) and 4.1 % in group 4 (n = 220). The following variables were included in the GEE model but did not reach statistical significance: history of abortion, ≥3 sexual partners and use of chemical products for vaginal care. In groups 3 and 4 where this information was available, the use of plants for vaginal care was associated with LSIL+ (adjusted OR 2.70 (95 % confidence interval 1.04 - 7.01). The most common HPV types among HIV-positive women with ASCUS+ cytology (ASCUS or worse) were HPV68 (12 out of 50 samples tested), HPV35 (12/50), HPV52 (12/50) and HPV16 (10/50). Among women with negative/unknown HIV status, the most common types were HPV52 (10/40), HPV35, (6/40) and HPV18 (5/40). Conclusion: LSIL+ lesions are frequent among women in Kinshasa. The use of plants for vaginal care deserves attention as a possible risk factor for LSIL+. In this setting, HPV16 is not the most frequent genotype in samples of LSIL+ lesions.

Authors & affiliation: 
Catherine Ali Risasi, Kristien Verdonck, Elizaveta Padalko, Davy Vanden Broeck, Marleen Praet 1 Laboratory of Anatomopathology, General Reference Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo 2 N.Goormaghtigh Institute of Pathology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium 3 Institute of Tropical Medicine, Nationalestraat 155,Antwerp, Belgium 4 Department of Microbiology, Clinical Chemistry and Immunology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium 5 Faculty of Medicine and Life Sciences, Hasselt University,Agoralaan Building D, Diepenbeek, Belgium 6 International Centre for Reproductive Health, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium
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Published In: 
Infectious Agents and Cancer 10
Publication date: 
Wednesday, June 24, 2015