Cervical cancer study reveals worrying trend for young women

24 June 2021

Zambian study finds women living with HIV aged 20-29 are most at risk of cervical cancer, closely followed by adolescent girls

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A 9-year study of cervical cancer screening in Zambia suggests that young women living with HIV are the group most at risk of cervical cancer.

Cervical cancer is the fourth most common cause of cancer-related death among women in the world. Poor uptake of screening services contributes to this high death rate.

The study of 11 government health facilities in Lusaka was based on data from the Cervical Cancer Prevention Program in Zambia (CCPPZ) collected between 2010 and 2019.

The records of more than 180,000 women who had been screened for cervical cancer were analysed.

Around one-third of women screened were aged 30–39 (30%), one quarter (26%) were aged 20–29 and 18% were aged 40-49. A small number of women who were screened were aged 50 and above or 20 and below. The median age of women was 34.

Around 10% of the screenings found pre-cancerous lesions, which if left untreated can develop into cervical cancer. Around three-quarters (76%) of women with positive screens received treatment.

Young women living with HIV were three times more likely to screen positive for pre-cancerous lesions than other young women.

Women aged between 20 and 29 who were living with HIV were the age group most likely to screen positive (19%). Adolescent girls (ages 19 and below) were the next group most likely to screen positive (18%).

Previous research has suggested that women living with HIV are most at risk of developing cervical cancer between the ages of 30 and 40.

The increased prevalence of cervical lesions among young women could be associated with having sex at an early age, having multiple sexual partners, and being less aware or having less access to the HPV vaccination. This vaccine protects against cervical cancer. Women living with HIV’s increased risk of pre-cancerous lesions could also be linked to the effects of HIV on the immune system if women are not on effective antiretroviral treatment (ART). Not being on effective ART increases the risk of having a lower immune system, and this can lead to chronic HPV infection and vulnerability to lesions.

In Zambia, the guidance is to provide same-day treatment to all women with pre-cancerous lesions. But despite being more likely than other women to have pre-cancerous lesions, women living with HIV were less likely to receive same-day treatment.

CCPPZ has increased the number of Zambian women getting screened for cervical cancer since it began in 2006. The number of women screened each year increased from more than 15,300 in 2010 to nearly 25,500 in July 2019, an annual increase of 66%. Most appointments (78%) were first-time screenings.

Peer educator referrals were the most common reason young women came to be screened. For older women, health facility and community referrals led to the most screenings. This suggests that different strategies should be used to target and increase uptake among different age groups.

These findings could help policymakers and others design strategies to expand cervical cancer screening services. To tackle cervical cancer, the World Health Organization recommends that 90% of girls have HPV vaccinations by the age of 15, 70% of women are screened at the ages of 35 and 45, and 90% of women with both pre-cancerous and invasive cervical cancer receive treatment.

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Written by Hester Phillips