1. Dr Julius Mwaiselage MD PhD Chief, Cancer Prevention and Research Ocean Road Cancer Institute

2. CONTENTS Background Cervical cancer screening at ORCI

3. Area = 940,000 sq km Popul. = 34.6m (2002) IMR = 99/1000 MMR = 540/100000 Life expectancy = 52yrs Average growth rate = 2.9% TANZANIA

4. Tourist attractions Serengeti National Park Mountain Kilimanjaro Zanzibar Beaches

5. General Cancer Profile In 2011, 40,000 new cancer cases Only one specialized cancer center, Ocean Road Cancer Institute Established in 1996

6. NEW CANCER CASES TREND AT OCEAN ROAD CANCER INSTITUTE 2006 - 2010 Type of Cancer20062007200820092010 Cervical cancer9551006128813741510 Kaposi sarcoma295404418447681 Breast cancer244245275322386 Esophageal cancer181256282307380 Head and neck155206244272289 Burkitts lymphoma201199226245186 Leukemias467887103142 Urinary bladder46888798109 Skin cancer40108111123129 Eye cancers4676809584 Others598472382390299 TOTAL28073138348037764195

7. Cervical cancer screening at ORCI Started in 2002 with support from IARC through Bill and Melinda Gates Focused on Visual Inspection with Acetic Acid and Lugols iodine technique Aim was to evaluate performance of VIA and VILI (Findings published: Ngoma et al. Int J Gyn Obs. 2010. 109: 100-104) It was a three-year project (2002 – 2005), then continued as a service from 2006

8. Visual Inspection Screening Method All women aged 25-50years Counselling and baseline data collection HIV counselling and testing – Bioline/determine Apply 5% acetic acid or/and lugols iodine For VIA+, colposcopy is performed Record observation and results Discuss results with client

9. After HIV Counseling and testing Those who are HIV positive are referred to the CTC clinic for continuation of care They are re-screened yearly Those who are HIV negative and VIA negative, are rescreened after three years

10. Data collected Name, age, phone nr, occupation, education level Marital status, age at marriage, number of pregnancies Visual inspection findings Colposcopy findings Biopsy taking – and results Treatment performance – cryotherapy, LEEP HIV status

11. Results A total of 25632 women have been screened Screening is done 4 days per week i.e. Monday to Thursday 3 doctors and 4 nurses are running the clinic Screening and treatment is free In case of a biospy, then client pay for HP examination Those who are HIV positive are referred to CTC clinic – pts are free to choose the clinic

12. Socio-demographic characteristics Variable Mean age38.4 yrs Primary education70.4% Mean age at marriage19.9 yrs Married women80.2% Mean nr of pregnancies4.6

13. Presenting gynecologic symptom VariablePercentage Lower abdominal pain33.9% Excessive vaginal discharge19.6% Genital area ulcers28.1% Genital area itching33.0% Post-coital bleeding1.3%

14. VIA Findings GradeNumber (%) VIA positive3241 (12.6%) Cervical cancer733 (2.9%) VIA negative21658 (84.5%)

15. HIV status started in 2009 - 10253 ResultsNumber (%) Overall HIV Positive 1230 (11.9%) VIA+1315 (12.8%) VIA+ HIV+434 (33.0%) VIA+HIV-881 (67.0%)

16. Other initiatives - Partners JHPIEGO - Started cacx prevention program in 2010 - Re-trained HCW in Morogoro – Kilombero - Support established screening clinic PATH - Started cacx prevention program in 2010 - Trained HCW in Mwanza – Geita - Support established screening clinic ICAP - Started cacx prevention program in 2010 - Support clinics in Kigoma and Pwani

17. Other initiatives - partners Ground for Health - Started cacx screening program in 2009 - Trained HCW in Kigoma and Kilimanjaro - Support established screening clinics

18. Other initiatives – National level Establishment of a coordination office at MOHSW Development of National cervical cancer service delivery guidelines – Done 2010 Development of Tanzania cervical cancer training package – Ongoing Development of National cervical cancer prevention and control strategy – In printing phase

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