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Table of Contents   
COMMENTARY  
Year : 2016  |  Volume : 9  |  Issue : 6  |  Page : 379-380
Colposcopy and its challenges in Nigeria


Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Federal Teaching Hospital, PMB 102, Abakaliki, Ebonyi State, Nigeria

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Date of Web Publication14-Nov-2016
 

How to cite this article:
Ajah LO. Colposcopy and its challenges in Nigeria. Ann Trop Med Public Health 2016;9:379-80

How to cite this URL:
Ajah LO. Colposcopy and its challenges in Nigeria. Ann Trop Med Public Health [serial online] 2016 [cited 2017 Jul 20];9:379-80. Available from: http://www.atmph.org/text.asp?2016/9/6/379/193936
Cervical cancer is responsible for the death of many women globally and it is estimated that about 80% or more of the world burden of cervical cancer is in the developing countries.[1],[2] About 50.33 million Nigerian women are at risk of cervical cancer and the crude incidence rate per 100,000 population is 17.1 while the age standardized incidence per 100,000 population is 29.0.[3] The annual number of cervical cancer cases in Nigeria is 14,089 and the annual number of cervical cancer deaths is 8,240.[3] This is a major public health challenge and the number may increase if the effort toward its reduction is not put in place. The high cervical cancer burden in our environment has been ascribed to ignorance, lack of resources, and unavailability of nationally organized screening programs.

Colposcopy is one of the cervical cancer screening procedures aimed at early detection and treatment of cervical epithelial abnormalities. A colposcope is a binocular microscope used for direct visualization of the cervical, vaginal, vulval, and anal epithelia. It was produced by Hans Hinselmann, a German gynecologist, in 1925.[4] Since then, it has undergone some modifications aimed at improving the accuracy of its results. Colposcopy complements the Papanicolaou (Pap) smear and human papillomavirus (HPV) deoxyribonucleic acid (DNA) test, especially when the client has abnormal cervical cytology or is HPV positive. However, there are some challenges associated with colposcopy in Nigeria. These challenges comprise the sociodemographic characteristics of Nigerians and the issues related to the procedure, itself.

Nigeria does not have an organized cervical cancer screening program. What is currently obtainable in Nigeria is opportunistic screening by using mainly Pap smear cytology and visual inspection with acetic acid or Lugol's iodine. HPV DNA screening test is available in very few centers in Nigeria. Even with opportunistic screening, the acceptance is very poor. This may be responsible for the paucity of clients that need colposcopy services. More so, there are very few colposcopy service centers in Nigeria. The reason may be due to the paucity of qualified colposcopists and the facilities in Nigeria. The cost of this colposcopy service may additionally hinder its uptake by the Nigerian clients. However, there was a significant default in uptake of these services even when they were provided free.[5],[6] The main reason adduced to the poor uptake by the women was fear of the possible outcome.[5]

Nigeria currently does not have any guidelines on cervical cancer screening. Most of the centers that have colposcopy service rely their screening on World Health Organization (WHO) guidelines.[7] Therefore, the formulation of national guidelines may consider the local peculiarities and help strengthen the colposcopy services in Nigeria. When compared with Pap smear screening, colposcopy takes more time. Even in experienced hands, colposcopy does not take less than 5 min.[3] Type 3 transformation zone leads to unsatisfactory colposcopy with its drawbacks. Even though endocervical curettage is done in such situations, it causes more painful discomfort and adds extra cost to the clients. Despite that, the accuracy of colposcopy on the detection of the preinvasive and invasive cervical lesions depends on the experience of the colposcopist; the gold standard is the histologic verification of the lesions.[8] Another area of controversy is the mode of anesthesia during colposcopy and biopsy. Some colposcopists feel that it is not necessary, but others prefer local infiltration with xylocaine during biopsy. Some even prefer cervical blocks, while general anesthesia is used in extensive surgeries such as cone biopsy. Some centers in Nigeria use xylocaine infiltration in minor biopsy and cervical block in more extensive surgery. Xylocaine infiltration is cheaper, done in the cervical cancer screening clinic and ensures faster recuperation by the clients.


   Conclusion Top


In conclusion, colposcopy services are very important in stemming the tide of high cervical cancer burden in Nigeria. The challenges militating against the achievement of this goal have been discussed. There is a need to have an effective national society of coloposcopy and cervical pathology in Nigeria. This will help engender training and retraining of members as well as create public awareness on the importance of cervical cancer screening among the target population. The men have to be involved in this sensitization, because a previous study has shown that Nigerian women are more motivated to accept cervical cancer screening by their husbands and the community leaders.[9] All the stakeholders need to collaborate and formulate a policy aimed at starting an organized cervical cancer screening program. Free colposcopy services should be provided in every state of the federation and more colposcopists need to be trained in order to bridge the manpower gap in this subspecialty. If a quarter of the effort put by the stakeholders and the Nigerian community in the Ebola epidemic eradication in Nigeria can be applied in the reduction of cervical cancer, it will drastically reduce the high cervical cancer burden in our environment.

 
   References Top

1.
Sankaranarayanan R. Overview of cervical cancer in the developing world. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet 2006;95(Suppl 1):S205-10.  Back to cited text no. 1
    
2.
Okonufua F. HPV vaccine and prevention of cervical cancer in Africa. Afr J Reprod Health 2007;11:7-12.  Back to cited text no. 2
    
3.
World Health Organization. Nigeria: Human Papillomavirus and Related Cancers, Fact Sheet 2016. WHO/ICO HPV Information Centre. Institut Català d'Oncologia Avda. Gran Via de l'Hospitalet, 199-20308908 L'Hospitalet de Llobregat (Barcelona, Spain). Available from: http://www.hpvcentre.net. [Last accessed on 2016 Feb 24].  Back to cited text no. 3
    
4.
Fusco E, Padula F, Mancini E, Cavaliere A, Grubisic G. History of colposcopy: A brief biography of Hinselmann. J Prenat Med 2008;2:19-23.  Back to cited text no. 4
    
5.
Chigbu CO, Aniebue UU. Non-uptake of colposcopy in a resource-poor setting. Int J Gynaecol Obstet 2011;113:100-2.   Back to cited text no. 5
    
6.
Ajah LO, Chigbu CO, Onah HE, Iyoke CA, Lawani OL, Ezeonu PO. Cytologic surveillance versus immediate colposcopy for women with a cervical smear diagnosis of low-grade squamous intraepithelial lesion in a poor setting in Nigeria. Onco Targets Ther 2014;7:2169-73.  Back to cited text no. 6
    
7.
World Health Organisation (WHO). WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. WHO Guidelines Approved by the Guidelines Review Committee. Geneva: World Health Organization; 2013. p. 1-38.  Back to cited text no. 7
    
8.
Jordan J, Arbyn M, Martin-Hirsch P, Schenck U, Baldauf JJ, Da Silva D, et al. European guidelines for quality assurance in cervical cancer screening: Recommendations for clinical management of abnormal cervical cytology, part 1. Cytopathology 2008;19:342-54.  Back to cited text no. 8
    
9.
Chigbu CO, Onyebuchi AK, Ajah LO, Onwudiwe EN. Motivations and preferences of rural Nigerian women undergoing cervical cancer screening via visual inspection with acetic acid. Int J Gynaecol Obstet 2013;120:262-5.  Back to cited text no. 9
    

Top
Correspondence Address:
Leonard Ogbonna Ajah
Gynaecological Oncology Unit, Federal Teaching Hospital, PMB 102, Abakaliki
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.193936

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