A Description of Women with Abnormal Cervical Cytology Treated at a Peri-Urban Hospital in South Africa

Abstract

Background: Cervical cancer remains a major public health concern in South Africa. In rural and peri-urban areas, women face barriers to timely diagnosis and management of cervical dysplasia. Describing the demographics and treatment outcomes of women treated with a ‘see-and-treat’ approach is essential to advise effective patient management. Objectives: Primarily to (i) describe women referred with abnormal cervical cytology; (ii) evaluate their histopathological results. Secondly to (i) assess the prediction of histopathology by cytology; (ii) calculate the overtreatment rate of LLETZ. Study design: A retrospective, cross-section review of women referred to colposcopy and LLETZ clinic Klerksdorp/Tshepong Hospital Complex. Results: A total of 460 women were included. The median age was 42 years. HIV-positive rate was 71%, 44% had CD4 count >500 cells/mm3 and 92% had viral load <1000 copies/ml. High-grade lesions occurred in 84% of referral cytology. LLETZ was performed in 95% of patients, with 73% having CIN II or worse on histopathology. Complete excision was achieved in 42%.Squamous cell carcinoma was cytologically suspected in 3% but confirmed in two cases. Cytology over-call and under-call rates were 70% and 11% respectively. The overtreatment rate was 27%, and the overall short-term LLETZ complication rate was <1%. Conclusion: Women referred with cervical dysplasia in this peri-urban setting had a high burden of high-grade cervical pathology, particularly among HIV-positive women. Findings support the use of single-visit treatment model in a resource limited setting to improve access to care and reduce delayed treatment.