Risk Factors for Cervical Precancer Lesions among Women Attending Cervical Cancer Screening Clinics in Harare, 2013

Abstract

Background: Cervical cancer is the most common cancer in women in Zimbabwe. Preliminary analysis of the prevalence of precancer lesions of the cervix in Harare City revealed that the prevalence is around 7%. This is relatively high compared to those in the southern African region (3%). If the burden of the cervical cancer is to be reduced then risk factors for the precancer cervical lesions (precursor to cancer) for women in Harare have to be established. Methods: A total of 180 women who were attending Visual Inspection with Acetic acid and Cervicography (VIAC) clinics in Harare were enrolled in a case control study. A case was a woman 18 and above years with histologically confirmed cervical dysplasia. Data on demographic characteristics and risk factors for precancer lesions of the cervix were obtained with consent and these were then compared between the cases and controls. Results: The significant risk factors were having more than one sexual partner (OR=1.9; 1.21-3.72), being HIV positive (OR 8.4; 4.17-17.09), early sexual debut (<15years) (OR=3.4; 1.18-9.8), a previous history of any form of STI (OR= 3.06; CI= 1.64-5.69) and being single (OR=2.30; 1.12-6.56). HIV infection was found to have an effect modification for the association of sexually transmitted infections (STIs) and precancer lesions. History of genital warts appeared to have the strongest association (OR=4.29; CI= 1.37-13.40) with precancer lesion compared to other forms of STIs. Conclusion: The association of precancer lesions and HIV, STIs suggest that there is need to reduce the prevalence of HIV and STIs if the prevalence of the cervical precancer lesions is to be reduced. To achieve this strengthening health education on use of barrier methods to prevent STIs and HIV is required and there is need for integration of HIV services with cervical cancer screening for early detection in these women at higher risk.