False-Positive Screening, Over-Referral, and Length of time between Cervical Cancer Early Detection and Confirmed Diagnosis Over Nine Years in Lusaka, Zambia

Q: What was the study purpose regarding cervical cancer in Zambia?

To examine the time between suspicion of cervical cancer at screening clinics and histopathologic confirmation in Lusaka Province, Zambia.

Q: How were the study participants and data collected?

Records of 3,483 women with VIA-identified suspected cancerous lesions referred from Lusaka Province screening facilities (2014–2022) were linked with histopathology results from the University Teaching Hospital.

Q: What did the study find about false positives and wait times?

False-positive VIA results made up about 90% of all referrals, and women living with HIV had longer wait times for histopathologic results, particularly rural residents compared with urban residents.

Sep 23, 2026

Uploaded by hdkawk

Purpose examines why, despite an efficient cervical cancer early-detection program in Zambia, many cases are diagnosed at advanced stages. Methods analyze 3,483 women with VIA-identified suspected lesions referred from Lusaka Province screening facilities between 2014 and 2022, linking referral records to histopathologic confirmation at the University Teaching Hospital. Results show false-positive VIA results account for ~90% of referrals, with longer waits among women living with HIV, especially rural women. Conclusion recommends expanding rural service infrastructure and continuing provider training to reduce delays, optimize sensitivity, and relieve histopathology overload.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

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Abstract

Purpose

Methods

Results

Conclusion

Introduction

Background and burden of cervical cancer in Zambia

Role of HIV and screening approaches

Journal of Epidemiology and Global Health (2026) 16:3 [https://doi.org/10.1007/s44197-025-00478-8](https://doi.org/10.1007/s44197-025-00478-8) RESEARCH False-Positive Screening, Over-Referral, and Length of time between Cervical Cancer Early Detection and Confirmed Diagnosis Over Nine Years in Lusaka, Zambia Rachael E. Hinkel1 · Mulele Kalima2 · Susan C. Msadabwe3 · Catherine K. Mwaba3 · Fred C. Ng’uni2 · Ronald Fisa4 · Bushimbwa C. Tambatamba5 · Alick Chuba6 · Mario J. Trejo7 · Kennedy Lishimpi8 · Amr S. Soliman9 Received: 1 April 2025 / Accepted: 10 October 2025 © The Author(s) 2025 Abstract Purpose While Zambia has an efficient program for early detection of cervical cancer, most cases are diagnosed at advanced stages. This study examined the time between suspecting cancers at screening clinics and histopathologic confirmation of cervical cancer in the Lusaka Province of Zambia. Methods This study included the records of 3,483 women with suspected cancerous lesions identified by visual inspection of the cervix (VIA) who were referred from Lusaka Province screening facilities from 2014 to 2022. The study linked screening records with corresponding histopathologic results of the lesions after examination at the University Teaching Hospital. Variables abstracted from the medical records included age, human immunodeficiency virus (HIV) status, district of residence and referral clinic, and dates of referral and confirmed diagnosis. Results False-positive VIA results constituted about 90% of all referrals. Women living with HIV (WLWH) had longer wait times between screening referrals and receipt of histopathologic results, most notably women coming from rural settings (median of 146 days) compared to urban settings (median of 69 days) (p< 0.05). Among women diagnosed with low-grade intraepithelial lesions, WLWH had a 63% higher risk of confirmed cancer diagnosis (CI: 1.16, 2.29) than women not living with HIV. For high-grade intraepithelial lesions, the adjusted HR showed WLWH having a 17%(CI: 0.89, 1.53) higher risk of confirmed cancer diagnosis compared to women not living with HIV. Conclusion The high rate of false-positives and long wait times call for expanded service infrastructure, particularly in rural settings, and continuing provider education/training to optimize screening sensitivity and shorten wait times in the Lusaka Province. Such measures may reduce the overload on the existing histopathology infrastructure and may provide lessons for other limited-resource countries facing similar cancer control and prevention challenges. Keywords Cervical cancer · HIV · False positive · Visual inspection of the cervix (VIA) · Zambia 􀀍 Amr S. Soliman [asoliman@med.cuny.edu](asoliman@med.cuny.edu) 1 Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA 2 Lusaka Provincial Health Office, Lusaka, Zambia 3 Cancer Diseases Hospital, Lusaka, Zambia 4 Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia 5 Department of Public Health, Ministry of Health, Lusaka, Zambia 6 University Teaching Hospitals – HIV/AIDS Program, Lusaka, Zambia 7 Department of Epidemiology – Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA 8 Office of the Permanent Secretary – Technical Services, Ministry of Health, Lusaka, Zambia 9 Department of Community Health and Social Medicine, City University of New York School of Medicine, 160 Convent Avenue, New York, NY 10031, USA 1 3 1 Introduction Cervical cancer is the second leading cause of cancer-related mortality among women globally, resulting in more than 265,000 deaths annually [1] . Nine in ten women who die from cervical cancer live in low-and middle-income countries (LMICs) such as Zambia, which ranked third highest in cervical cancer incidence globally in 2018 [2, 3] . Zambia reported a cerv

FAQs

What was the study purpose regarding cervical cancer in Zambia?

To examine the time between suspicion of cervical cancer at screening clinics and histopathologic confirmation in Lusaka Province, Zambia.

How were the study participants and data collected?

Records of 3,483 women with VIA-identified suspected cancerous lesions referred from Lusaka Province screening facilities (2014–2022) were linked with histopathology results from the University Teaching Hospital.

What did the study find about false positives and wait times?

False-positive VIA results made up about 90% of all referrals, and women living with HIV had longer wait times for histopathologic results, particularly rural residents compared with urban residents.

Sep 23, 2026

Uploaded by hdkawk