Abstract 19: Expanding Cervical Cancer Screening in Mozambique: Challenges Associated With Diagnosing and Treating Cervical Cancer
Authors: Batman Samantha , Rangeiro Ricardina , Baker Ellen , Monteiro Elaine , Carrilho Carla , Changule Dercia , Daud Siro , Osman Nafissa , Neves Andrea , Atif Hira , De Jesus Celda , Mariano Arlete , Moretti-Marques Renato , Vieira Marcelo , Fontes-Cintra Georgia , Lopes Andre , Batware Jean Claude , Luis Elvira , Lorenzoni Cesaltina , Schmeler Kathleen , Salcedo Mila 
Published: June 2023

Abstract
Purpose: Cervical cancer remains the most frequently diagnosed cancer among Mozambican women. Treatment options are limited as there is only one radiation machine for the population of 31 million. The MULHER cervical cancer screening study was implemented in January 2020 in Maputo, Mozambique to increase screening and detection of women with cervical cancer. We seek to describe the challenges and barriers associated with providing cancer care to this cohort.
Methods: As part of the MULHER study, women ages 30-49 were prospectively enrolled and offered screening with primary human papillomavirus testing (HPV) testing followed by treatment, as appropriate, with ablation or excision for screen-positive women. Women with suspicion for cancer were referred to gynecologic oncologists who were previously trained as part of the International Gynecologic Cancer Society (IGCS) Global Curriculum and Mentorship Program. To date, three Mozambican fellows have graduated and are providing care in Maputo, with three fellows currently in training.
Results: Between January 2020 and December 2022, 9,089 women underwent cervical cancer screening and 30 women were diagnosed with cancer. The mean time from biopsy to pathology report was 1.1 month (range 0.5-8.5 months) and the mean time from biopsy to first treatment was 7.7 months (range 1.9-22.7 months). In this cohort, four patients (13.3%) had early stage disease, 18 (60.0%) had locally advanced disease, 1 (3.3%) had distant metastatic disease, and seven (23.3%) were either unstaged or staging information was missing. Six patients (20.0%) died without treatment and seven patients (23.3%) are still awaiting treatment. No patients received chemoradiation, with those patients who received radiotherapy first receiving 9-12 cycles of chemotherapy due to long wait times for radiation.
Conclusion: As cervical cancer screening programs are scaled up in low-resource settings, there will likely be an increase in the number of women diagnosed with cancer. Our review of this cohort shows that there are significant barriers to cancer care, even in a research cohort. These must therefore be addressed and include lack of accurate charting, lack of access to pathology and radiotherapy, and lack of a prioritization system within radiotherapy infrastructures to first address patients with potentially curative disease.
Citation Format: Samantha Batman, Ricardina Rangeiro, Ellen Baker, Elaine Monteiro, Carla Carrilho, Dercia Changule, Siro Daud, Nafissa Osman, Andrea Neves, Hira Atif, Celda De Jesus, Arlete Mariano, Renato Moretti-Marques, Marcelo Vieira, Georgia Fontes-Cintra, Andre Lopes, Jean Claude Batware, Elvira Luis, Cesaltina Lorenzoni, Kathleen Schmeler, Mila Salcedo. Expanding Cervical Cancer Screening in Mozambique: Challenges Associated With Diagnosing and Treating Cervical Cancer [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 19.