Female genital mutilation and non-invasive cervical abnormalities and invasive cancer in Senegal, West Africa: A retrospective study

Abstract

We sought to investigate the relationship between exposure to female genital mutilation (FGM) and the main types of invasive cervical cancer (ICC), notably squamous cell carcinoma and adenocarcinoma. Background: Cervical cancer is the fourth most common cancer in women worldwide. In sub-Saharan Africa, it accounts for 22% of all cancers reported in women. Although preventable, the absence of regular screening and appropriate treatment for cervical cancer leads to late diagnosis and high mortality in African women. Female genital mutilation or cutting (FGM/C), also known as female circumcision, is a traditional practice that has been documented in 29 different countries, mainly in Northern and West Africa, areas of the Middle East, and some countries in Asia. Its long-term consequences include recurrent infection, urinary incontinence, pain with intercourse, complications during childbirth, and psychological effects. In Senegal, according to the 2014 Demographic Health Survey (DHS), an estimated 25% of women and girls, aged 15-49, have experienced FGM. Methods: We performed a secondary analysis using combined data from six research studies conducted in and around Dakar, Senegal from 1994 to present. Our study subjects included women who presented to outpatient clinics who were mostly asymptomatic but were screened for cervical cancer, and women with cancer symptoms who were referred to the Hopital Le Dantec for cervical cancer treatment. We conducted separate logistical regressions to estimate the odds ratio (OR) and 95% confidence intervals of having cervical abnormalities and of having ICC in women with FGM, each compared to a reference group of women with no cervical abnormalities. Results: After adjusting for age, children, HIV, CSW, smoking, marital status, ethnicity, visit year, education, sex partners, and age at first pregnancy, women with ICC were 2.24 times more likely to have had FGM (95% CI, 1.12-4.49). This association was strongest in our analysis restricted to HPV-positive women. We found that HPV-positive women with ICC were 3.20 times more likely to have FGM (95% CI 1.29-7.96). We did not find a significant association between women with cervical abnormalities and FGM (OR=1.11; 95% CI, 0.82-1.49). Similarly, there was no association between HPV and FGM (OR=0.82; 95% CI, 0.55-1.24) in analyses restricted to women who were negative for cervical abnormalities and ICC. Discussion: In our sample of Senegalese women with and without cervical abnormalities and invasive cancer, FGM was strongly associated with ICC. Our results suggest that while FGM may not be a significant risk factor for HPV or cervical abnormalities, it could increase risk for ICC, especially in the presence of HPV infection.