Skip Navigation LinksHome > Current Issue > Mexican Cervical Cancer Screening Study II: 6-Month and 2-Y...
Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0000000000000029
Original Articles

Mexican Cervical Cancer Screening Study II: 6-Month and 2-Year Follow-up of HR-HPV Women Treated With Cryotherapy in a Low-Resource Setting

Starks, David MD, MPH1; Arriba, Lucybeth Nieves MD, MPH1; Enerson, Christine L. MD2,3; Brainard, Jennifer MD4; Nagore, Norma MD5; Chiesa-Vottero, Andres MD4; Uribe, Jesús Villagran MD6; Belinson, Jerome MD1,3

Collapse Box

Abstract

Objective: To determine the efficacy and tolerance of cryotherapy in a visual inspection with acetic acid (VIA) triage protocol after primary human papillomavirus (HPV) screening in a low-resource setting.

Materials and Methods: This continuous series conducted over 2 years enrolled nonpregnant, high-risk HPV (HR-HPV)–positive women between the ages of 30 and 50 years, who resided in the state of Michoacán, Mexico, and had a history of no Pap smear screening or knowledge of Pap smear results within the last 3 years. These women were initially enrolled in the Mexican Cervical Cancer Screening Study II (MECCS II) trial and were treated with cryotherapy after VIA triage. They subsequently followed up at 6 months and 2 years for repeat VIA, colposcopy, and biopsy.

Results: A total of 291 women were treated with cryotherapy, of whom 226 (78%) followed up at 6 months. Of these 226 women, 153 (68%) were HR-HPV–negative; there were no findings of cervical intraepithelial neoplasia grade 2 (CIN2) or worse. The remaining 73 women (32%) were HR-HPV–positive; of these women, 2 had CIN2 and 3 had CIN3. Only 137 women followed up at 2 years. Of these 137 women, 116 were HR-HPV–negative and 21 were HR-HPV–positive. Of the 21 women positive for HR-HPV, 9 had negative biopsy results, 11 had CIN1, and 1 had no biopsy. The clearance rate of HR-HPV was 83% (95% confidence interval: 0.78–0.87). There were no biopsy findings of CIN2 or worse at 2 years. Before cryotherapy, of the 226 women, 15 (6.6%) were positive for endocervical curettage (ECC) and 5 (2.2%) were referred for surgical management. Of these 15 ECC-positive women, 10 (67%) followed up at 6 months and it was shown that no patient was ECC positive at that time point. Moreover, of the 15 ECC-positive women, 11 (73%) followed up at 2 years and it was shown that no patient was ECC positive at that time point. In our study, VIA had a false-positive rate of 5%.

Conclusions: Cryotherapy was an effective, acceptable, and well-tolerated means of treating cervical dysplasia in a low-resource setting.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology

Login

Article Tools

Share

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.