Development*of*a*Cervical*Cancer*Screening* and*Treatment*Program*in*Western*Kenya* Cervical*cancer*is*1*cause*of*cancer*death*for*women*in*Kenya* • Screening*is*difficult*for*mul?ple*reasons:*economic,*cultural,* • technical,*organiza?onal.* In*2009*a*pilot*study*of*150*conducted*comparing*HPV/VIA*and* • colposcopy* Permanent*clinic*established*with*subsequent*expansion*to*6* • different*sites*in*just*3*years* SeeTandTtreat*strategy*implemented*with*VIA*plus*cryotherapy/LEEP* • Support*for*screening*included*development*of*a*gyn*oncology* • program*which*included*radical*pelvic*surgery,*chemotherapy,*and* when*possible*radia?on*
Data* Median*?me*b/w*VIA+*(cryo*ineligible)*and* • Screened' 14,293' colposcopic*biopsy* * * *17*days* Number*of*centres* *6* Lost*to*followTup*b/w*VIA+and*colposcopic* • Colposcopy* 1350* biopsy* * * * * *28%* Cryotherapy* 579* Median*?me*b/w*colposcopic*biopsy*and* • LEEP* 239* LEEP*(CIN*2/3*only) * * * *49days* Radical*Hyst* *58* Lost*to*followTup*b/w*colposcopic*biopsy*and* • LEEP*(CIN*2/3*only) * * * *49%* CIN*1* 102* Median*?me*b/w*colposcopic*biopsy*and* • treatment*for*cancer * * *52*days* CIN2/3* 275* Lost*to*followTup*b/w*colposcopic*biopsy* • Microinvasive* 23* colpo/PB*and*hyst/chemo/rads*(CIS,* MicroICC,*ICC) * * * *59%* Invasive* 87* * **
Conclusions* • Successes* – Program*has*increased*capacity*in*a*short*period*of*?me* – Program*integrated*with*a*gynecologic*oncology*program*which*manages* invasive*cases*detected*through*screening* • Challenges* – Burden*of*disease*is*much*worse*than*expected,*number*of*posi?ve*screens* and*incidence*of*cancer* – Lost*to*follow*up*remains*a*significant*obstacle* – Physician*Human*Resource*limits*expansion* – Acquiring*permanent*funding*and*improving*sustainability* • Future** – Maintain*capacity* – Match*mobile*colposcopy*and*mobile*LEEP**to*need*in*regional*clinics* – Decrease*LTFU*using*phone*reminders*or*transport*subsidies* – Consider*integra?ng*cervical*and*breast*screening*at*same*visit*
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