Recurrence of preinvasive cervical lesion and associated factors among women who underwent loop electrosurgical excision procedure at Kilimanjaro Christian Medical Centre hospital, northern Tanzania

Abstract

BACKGROUND: Cervical cancer is a significant public health problem. Diagnosing preinvasive cervical lesion provides an important opportunity in early intervention to prevent progression to cervical cancer. Despite the achievements made in screening and management, the burden of cervical lesions remains high in East Africa, where mortality rates are disproportionately higher. In Tanzania, cervical cancer is the leading cause of death in women, yet there is limited information on the effectiveness of the procedures used in the treatment of preinvasive cervical lesions. OBJECTIVE: This study aims to determine the 1-year recurrence of preinvasive cervical lesions and its associated factors among women who underwent loop electrosurgical excision procedure (LEEP) treatment at Kilimanjaro Christian Medical Centre (KCMC) hospital from January 2018 to March 2023. METHODS: This is a retrospective cohort study including women screened for preinvasive cervical lesions at KCMC between January 2018 and March 2023 using visual inspection with acetic acid, Pap smear, or human papillomavirus testing. SPSS version 25 was used for data analysis. Univariate and multivariate logistic regression were used to check factors associated with the recurrence of preinvasive cervical lesions. RESULTS: Among 7335 women screened for cervical lesions from 2018 to 2023, 392 (5.3%) were positive for cervical lesions, and 286 (3.9%) were suspected of having cervical cancer. From 392 participants with cervical lesions, 196 were treated using LEEP and returned for follow-up. The recurrence rate of preinvasive cervical lesions was observed among 16 (8.2%) patients. In the final multivariable analysis, patients aged 35-49 years had a lower risk of preinvasive cervical lesion recurrence compared to those aged 20-34 years (adjusted odds ratio [95% confidence interval] = 0.10 [0.02-0.66]). Additionally, HIV-positive patients were found to have a higher risk of cervical lesion recurrence compared to HIV-negative women (adjusted odds ratio [95% confidence interval] = 4.51 [3.89-5.81]) and was statistically significant with P-value < 0.005. CONCLUSION: The reported recurrence rate of 8.2% highlights the importance of special interventions, particularly for high-risk groups such as HIV-positive women. Monitoring viral load and implementing tailored strategies for other at-risk demographics are crucial steps to mitigate recurrence risks.