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Cost-effective and sustainable technique for detecting precancerous lesions and cervical cancer applied in the Democratic Republic of Congo

Dr. Céline Tendobi, Director of Gynecology at Monkole Hospital (D.R. Congo), defended at the University her doctoral dissertation thesis with the results of the research

PhotoManuelCastells/Dr. Céline Tendobi (in the center), together with the co-directors of thesis , Dr. Luis Chiva and Dr. Silvia Carlos, from the University of Navarra.

07 | 03 | 2023

Cervical cancer (CCU) is a health problem worldwide and is the fourth most common cancer among women and the third most deadly. In the Democratic Republic of Congo, in particular, it is the most common cancer among women and the leading cause of mortality. However, there is currently no early detection program there that could decrease its incidence. For this reason, in 2017 the School of Medicine of the University of Navarra and the Monkole Hospital launched a project of partnership in Kinshasa to detect the disease prematurely and thus decrease the high mortality in the country.

Now, the results of this project have materialized in the doctoral thesis that Dr. Céline Tendobi, Director of Gynecology at Monkole Hospital, has just defended at the University of Navarra. "The goal of this research has been to describe the prevalence of human papillomavirus (HPV) infection (a necessary cause for development of cervical cancer) and preneoplastic cervical lesions in women who attended a free cervical cancer screening campaign carried out at Monkole Hospital," explains Tendobi. "Until now, diagnosis in most patients is made when the tumor is in advanced stages and usually involves early death of the patient."

The main milestone of work has been to evaluate the validity of a simple, very inexpensive and sustainable screening strategy to make an accurate diagnosis in 480 women. It is based on visual inspection with acetic acid and lugol, performed on site by a local team and student volunteers, and contrasted by external experts through cell phone images. The results were analyzed by comparing them with those obtained in cytology and human papillomavirus tests performed on cervical samples from Congolese women in the Clínica Universidad de Navarra of Pamplona. "It is, therefore, a sustainable technique that allows the implementation of an early detection program and the development of skills of the staff of Monkole to make a diagnosis of precancerous lesions and cervical cancer."

1% of positive screenings and 11% of precancerous lesions.

"This thesis provides data that was unknown in Kinshasa: on the one hand, it was found that 19% of the women were sexually infected with HPV, with the most frequent high-risk oncogenic HPV types being HPV-16, HPV-33, HPV-35 and HPV-52. Currently, they do not have access to the vaccine, but the data study allows us to estimate against which types the vaccine could protect them if they have it," says Dr. Silvia Carlos, co-director of the thesis .

In addition, given that the country does not currently have the resources to perform early detection with an HPV test or cytology, the researchers wanted to evaluate whether a much cheaper and simpler technique based on cervical visualization after applying acetic acid and lugol (similar to a few drops of vinegar and dye) to the cervix would allow valid screening. The technique made it possible to diagnose that 1% of the women who attended the screening had a diagnosis of cervical carcinoma and 11% had precancerous lesions. "It is a technique that is highly valid for ruling out the presence of lesions in the presence of a negative result ," explains Dr. Carlos.

Finally, the great contribution of project is that it has been observed that, with a brief training of the local staff with little experience and having the possibility of sharing the visualization images with an expert gynecologist remotely through a mobile, the strategy can be sustainable locally. This may allow the implementation of the early detection program at Monkole Hospital, as well as in other parts of the country.

Solidarity made science

For years the relationship between the School of Medicine, the Clínica Universidad de Navarra and the Monkole Hospital has been very fluid. In fact, during the last few summers, several groups of students and specialists have gone to the Congo carrying health material and implementing the program of early detection of cervical cancer, which is estimated to have an incidence in the country of 30-35 per 100,000 inhabitants. In July 2022 alone, 1120 women were treated.

"For us, it is a joy to be able to see a project of cooperation and solidarity turned into science and academia," confesses Dr. Luis Chiva, co-director of the thesis and director of the department of Gynecology and Obstetrics of the Clínica Universidad de Navarra. "Our goal with the research that has given rise to this doctoral thesis is to achieve in 10 years that in the area of influence of Monkole we can decrease from 30 to 4-6 cases per 100,000 inhabitants. This would make the hospital a model of preventive health change in the country, based on a perspective of efficiency and solidarity."