Browsing by Author "Mbatani, Nomonde"

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    Open Access
    A retrospective audit of young patients diagnosed with cervical cancer over ten years at Groote Schuur Hospital, Cape Town between 1 January 2003 and 31 December 2012, and their outcome at five-year follow-up compared to women in the prior decade
    (2020) Govindasamy, Suveshni; Mbatani, Nomonde; Fakie, Nazia
    Background : Cervical cancer is the second commonest gynaecological cancer amongst women worldwide and the leading cause of cancer deaths in developing countries – contributing 83% of new cases and 85% of all deaths annually to the burden of this disease. Information and awareness of this illness in the developing world is still inferior, and mortality is increasing. In the developing world, late presentation, advanced-stage disease and a poorly run screening programme (covering only 55% of the South African population) are all contributing factors to this statistic. Approximately 20% of all South African women in their reproductive age are also HIV positive. With the rising burden of cervical cancer and the emergence of HIV as an influencing comorbidity, South Africa adopted a national cervical screening programme, rolled out in 2000 as well as an HCT (HIV counselling and testing) programme formalised in 2011. With these initiatives now in place, this study examined trends and compared 5-year survival outcomes between two decades for cervical cancer among young women. Methods : The study undertook a retrospective audit of files and information on the pre-existing cervical cancer database, and appropriate data was extracted (HREC REF 344/2011). Survival and disease outcomes at five years, as well as time to recurrence, was assessed, together with other demographics of the study population. Patients included in the study were non-pregnant female patients, aged 40 years and younger at the time of registration with the Groote Schuur Hospital (GSH) Oncology Unit (LE 33). The diagnosis of cervical cancer had to have been confirmed histologically, as either squamous cell carcinoma or adenosquamous carcinoma or adenocarcinoma. Patients must have attended at the LE 33 unit on or from 1 January 1993 until and including 31 December 2012. The two decades were studied and 5-year outcomes from each decade were analysed and reviewed using Kaplan-Meier curves and univariate analyses. The study compared data using Log Rank tests and p-values. Findings : The two decade-groups under study showed no difference in trends of survival regarding age, treatment type and histology. Albeit small numbers, adenocarcinoma was the histology that had the best probability of survival during both decades. There were more patients with early-stage cancer (stage 1 and 2) diagnosed in decade B (2003 – 2012) than A (1993 – 2002). Within this early-stage cervical cancer cohort, there is a trend toward more locally-advanced (stage 2) cancer in the more recent decade. The proportion of patients presenting with stage 1a and 1b cancer with tumours 4 cm and less has halved from decade A to decade B. The proportion of stage 2 cancers presenting with tumours 2 – 4cm in size during decade B has risen almost 3-fold to that of decade A. This suggests a developing trend of presentation of more locally-advanced cancer. During both decades, stage 1 cervical cancers had the best probability of survival, with an improvement in mean survival from decade A (average of 44 months) to decade B (average of 58 months). The trend of stage 2 disease has deteriorated, with a decrease in mean survival (from 48 months in decade A to 21 months in decade B), an increase in cancer-related deaths and a shorter time to relapse. The number of patients presenting with late-stage disease (stages 3 and 4) has declined. HIV positive status played an influential role in tumour size on presentation and probability of 5-year disease-free survival. Young women who were HIV positive also fared less favourably when compared to NP (not positive) women in terms of mean survival. Due to the small sample size and that the majority of patients in decade A were untested, further HIV comparisons were not credible. Interpretation : The study suggests a moving trend towards young patients that are being diagnosed with the more locally-advanced early-stage disease in the more recent decade than ten years prior. HIV status seemingly played an influential comorbid role in patients diagnosed with cervical cancer. Patients with the locallyadvanced disease appear to have worse outcomes in the latter decade. In an attempt to curb this potentially curable disease in this subset of young women, a greater focus on earlier screening interventions, prompt diagnosis and appropriate and timeous treatment of cervical cancer, together with optimisation of comorbidities like HIV are needed.
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    Hygiena Study: audit of women managed with Cone Biopsy at Groote Schuur Hospital from 1st April 2013 to 31st October 2015
    (2017) Kadwa, Khatija; Denny, Lynette; Mbatani, Nomonde
    INTRODUCTION: Cervical cancer is the second commonest cancer in South Africa and the commonest amongst Black females with a Lifetime Risk (LR) of 1:35. In South Africa the problem has been compounded by the HIV epidemic as well as a lack of resources and infrastructure to offer an adequate screening and treatment programme. Cone biopsies are one of the diagnostic and sometimes therapeutic modalities used to assess and treat cervical precursors and cervical cancer. Unfortunately, cone biopsy of the cervix remains a morbid procedure often performed on young women in the reproductive age group and has resultant complications. OBJECTIVE: To audit the demographics, indications, histology and post cone management and outcome of women requiring cone biopsies of the cervix, at Groote Schuur Hospital Colposcopy Clinic between 1st April 2010 and 31st October 2013. METHODS: A group of women attending the colposcopy clinic, and requiring cone biopsies between 1st April 2010 and 31st October 2013 were identified from a computerized database, known as the Hygiena Database. Women who had an incomplete dataset were excluded. Folder review and review of the National Health Laboratory Services was also conducted. Patient demographics, indications, cone histology and follow up at 4-6 months, 10-12 months and > 12 months were analysed. Age, parity, HIV status, CD4 count, ARV status and cone margin involvement were included in the univariate and multivariate analysis to determine predictors of persistent disease RESULTS: Three hundred and seventy six cone biopsies were performed during the study period, with a mean age of 42.3 years, mean parity of 2. The majority of women [56,7% (213/376)] were HIV positive. The final histology indicated that 65,2% (246/376) of the women had high-grade disease (CIN 2/3 or HSIL) and 12,5% (47/376) had microinvasion. Ectocervical margins were clear in 57,6% (212/368) of cases and endocervical margins were clear in 54,6% (201/368) of specimens. Fifty-one cancers were detected during the study period. In the multivariate analysis age 40-49yrs (RR 1.4, 95% CI 1.01-2.0: p=0,043), ectocervical margin involvement with CIN 2/3 (RR 1.8, 95% CI 1.1-3.0: p-0.017) and endocervical margin involvement with CIN 2/3 (RR 1.5, 95% CI 1.04-2.3; p=0,031) and microinvasion ( RR 2.4, 95% CI 1.4-4.3; p=0.003) were all predictors of persistent disease. CONCLUSION: The use of cone biopsy is a valid diagnostic and sometimes therapeutic procedure at Groote Schuur Hospital with significant detection of high grade disease and cervical cancer. Women aged 40-49 years and positive cone margins are strong predictors of persistent disease. Improved compliance and a reduction in positive margins are two areas that need to be addressed to improve the current treatment programme. Use of cone biopsy as surgical therapy for early stage cancer appears promising but needs further study.
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    Open Access
    Look and Leep: How are we doing? An audit of GSH colposcopy clinic from 1 January 2017 to 31 December 2021
    (2024) Gaskell, Marlene; Mbatani, Nomonde
    Background: Cervical cancer persists as the second most common cancer in women in developing countries. The prevalence of cervical cancer has markedly decreased in well developed nations, primarily attributed to the implementation of efficacious screening services. Such screening services pose formidable challenges in developing countries. Therefore, the ‘See-and-Treat' strategy has been adopted in South Africa and other developing countries to reduce loss to follow up and prevent patients to present with advanced disease, thereby reducing the morbidity and mortality associated with cervical cancer. The main limitation of this approach is the risk of overtreatment, identified as final histopathology without preinvasive cervical lesion. The objective of our study is to identify the rate of overtreatment at a colposcopy clinic in a tertiary center with extensive experience in colposcopy and to detect possible factors associated with this rate. Methods: This was a retrospective, descriptive cohort study that analyzed data from 715 women who had undergone the ‘See-and-Treat' treatment approach from 2017 to 2021 at Groote Schuur Hospital Colposcopy clinic. Overtreatment was defined as final histopathology results of Cervical Intraepithelial Neoplasia grade 1 (CIN 1) or less. Results: Of the 715 women, there 109 (15.24%, 95% CI 0.13 – 0.18) with a histopathology result of CIN 1 or less. There was a statistically significant association between age and the odds of overtreatment as well as between HIV negative women, when compared to HIV positive women on treatment, and the odds of overtreatment. No statistically significant association was found between smoking status, HIV viral load, CD4 count or parity. Conclusion: The overtreatment rate in this study can be considered acceptable and comparable with rates reported in the literature. HIV negative women should be considered for a biopsy prior to LEEP to decrease risk of overtreatment, but the risk should be weighed against the risk of loss to follow up. Keywords: Cervical intraepithelial neoplasia, Colposcopy, See-and-Treat, Overtreatment, Negative histology.
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    Open Access
    Molar pregnancy: A fifteen - year experience of a single tertiary institution
    (2022) Camroodien, Sedick; Mbatani, Nomonde
    Background: Gestational trophoblastic disease (GTD) is a group of uncommon conditions associated with pregnancy that arise from abnormal placental trophoblastic tissue following abnormal fertilization (1). Despite its rarity, it is of clinical and epidemiological importance because it affects women in the reproductive age group and is associated with morbidities and may sometimes be fatal (2). Molar pregnancy represents as two entities, complete or partial mole, which are mostly benign and can be distinguished by gross morphology, histopathology and genetic analysis (3). The incidence and etiologic factors contributing to the development of GTD have been difficult to characterize. Problems in accumulating reliable epidemiologic data can be attributed to inconsistencies in case definitions, inability to adequately characterize the population at risk, no centralized databases, lack of well-chosen control groups against which to compare possible risk factors, and rarity of the diseases (4). Several potential risk factors for molar pregnancies have been suggested. These include paternal age, vitamin deficiencies, maternal genetic translocations and environmental toxins. The only clear data relate to the impact of maternal age and the previous occurrence of a prior molar pregnancy (3,5,6). With minimal data from African countries about GTD, there remains a greater need for early recognition, timely referral and prompt and proper treatment of this condition (7). Aim: The aim of this descriptive study was to provide a detailed analysis of all patients diagnosed with molar pregnancy at Groote Schuur hospital (GSH) for the period January 2004 – December 2019. Methodology: This was a retrospective descriptive study of all women who were referred and followed up at the molar clinic at GSH with a confirmed histological diagnosis of molar pregnancy during the period 2004 – 2019. Subjects were identified from the molar clinic register at GSH, and folders retrieved for those meeting the inclusion criteria. Analysis was by simple frequencies and rates using SSPS statistical software. Subgroup analyses was performed by chi squared and t-tests. Results: There were 554 057 deliveries and 235 cases of molar pregnancies during that period, with an incidence of 0.42/1000 deliveries. Women aged 20 – 40 years and multiparous women constituted 78.7% and 59.8% of patients. Most (51.3%) patients were diagnosed in their second trimester. The most common presenting complaint was vaginal bleeding (37.4%), and the commonest complication was hyperthyroidism (16.6%). Twenty-six (11.2%) patients required a blood transfusion. Ten patients (4.2%) required a second evacuation with only 4 patients (1.7%) requiring a hysterectomy due to excessive haemorrhage. Patients with molar pregnancy normalized their HCG at 12 weeks post evacuation. There were 47 cases of persistent disease, of which 42 cases were referred for chemotherapy. The remaining 5 cases did not require chemotherapy as they achieved spontaneous regression after the second evacuation. Suction evacuation was performed in 97.4%. With regards to follow up, 44.3% of patients defaulted post evacuation surveillance and care. Conclusion: As the incidence of molar pregnancy in our centre continues to decline, it is important that we take the necessary steps to improve the follow-up protocols for patients with this condition. Doing so will avoid experiencing loss to follow-up.
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    Prevalence of gynaecological disease in women with an HMLH1 mutation in the Northern Cape province: Survey of a population with Lynch Syndrome in South Africa
    (2016) Lerm, Marlize; Mbatani, Nomonde
    Objective: Lynch syndrome, previously called hereditary non-polyposis colorectal cancer (HNPCC), is one of the most common hereditary cancer syndromes with an association with gynaecological cancers. Members of affected families have an increased risk for colon cancer as well as extra colonic sites; in particular endometrial and ovarian cancer. A cohort of patients with Lynch syndrome in the Northern Cape, South Africa has been identified and followed up. According to recommendations by the International Collaborative Group on HNPCC (ICGHNPCC); women affected with the gene mutation warrant full gynaecological assessment to exclude endometrial and ovarian cancer. Thus far the recommended screening has not been possible and the apparent prevalence of gynaecological cancer or premalignancies among this high risk group has not been established. The aim of this study was to determine the actual apparent prevalence of gynaecological pathology in this cohort of patients; by way of screening. Methods: Women with a known gene mutation, or close relatives of affected family members, utilising the annual colorectal service in the Northern Cape, who fulfilled the inclusion criteria, were recruited to undergo gynaecological evaluation. The participants had a gynaecological examination which included a Papanicolaou smear, a pelvic ultrasound and endometrial sampling. The resultant data was captured on an Excel spread sheet and a descriptive analysis was done. Results: In total 43 women were recruited, of which 18 were postmenopausal and 25 premenopausal. 35 of these women had a known hMLH1 gene mutation. The eight remaining women had either normal genotyping (n=7) or were awaiting molecular test results (n=1). Only twenty-one of these participants agreed to endometrial sampling, in addition to pelvic ultrasound and gynaecological examination. Histological results were therefore available for the 21 participants. One patient was diagnosed with a grade-2 endometroid adenocarcinoma. No cases of endometrial hyperplasia were found. Thirty pelvic ultrasound scans were performed. Of these, one patient had an enlarged adnexal mass. No cervical premalignancies were diagnosed on cervical smears, with one abnormal smear of atypical cells of unknown significance (ASCUS) diagnosed. Conclusion: The apparent prevalence of gynaecological disease in this study population was lower than expected. We conclude however that this high risk group of women should still undergo regular gynaecological screening which should include history taking and clinical examination. Screening using routine endometrial sampling and pelvic ultrasound in asymptomatic women did not appear to be beneficial.