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Peer-reviewedCC BY 4.0PLOS One

Cervical leukoplakia in Ghana: Unveiling diagnostic challenges and informing low-resource screening strategies

  • Kofi Effah1
  • Ethel Tekpor2
  • Maxwell Afetor3
  • Joseph Emmanuel Amuah4
  • Comfort Mawusi Wormenor5
  • Annita Edinam Dugbazah6
  • Stephen Danyo7
  • Seyram Kemawor8
  • Edna Sesenu9
  • Christopher Nyamekye
  • Emmanuel Timmy Donkoh
  • Chrysantus Kubio
1 more authors
  • Kofi Adum-Attah
9 affiliations
  1. 1Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana
  2. 2Department of Obstetrics and Gynaecology, Catholic Hospital, Battor, Ghana
  3. 3Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
  4. 4Volta Regional Health Directorate, Ghana Health Service, Ho, Volta Region, Ghana
  5. 5School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
  6. 6University of Ghana Medical Centre, Accra, Ghana
  7. 7Central Laboratory, Catholic Hospital, Battor, Ghana
  8. 8Screen-and-Treat Research Group, Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Ghana
  9. 9Department of Family Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
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Abstract

Background: Visual Inspection with Acetic acid (VIA) is widely used for detecting cervical (pre)cancer in resource-limited settings due to its simplicity and cost-effectiveness. However, the finding of cervical leukoplakia, poses diagnostic challenges. Methods: This retrospective observational study evaluated the prevalence, associated risk factors, and referral outcomes of cervical leukoplakia among 13,861 women previously screened for cervical cancer in Ghana between June 2016 and May 2024. Screening approaches included VIA alone, mobile colposcopy alone, or VIA/mobile colposcopy combined with other tests (HPV DNA testing and/or cytology). Results: Among 120 women (0.9%) with leukoplakia, 112 (93.3%) did not have acetowhitening on VIA/mobile colposcopy, and 21 (17.5%) received LEEP. The histopathology results ranged from no Cervical Intraepithelial Neoplasia (CIN) (15) to CIN I (2), CIN II (1), and CIN III (3). High-risk HPV positivity (aOR: 30.27; 95% CI: 3.56–257.37) and HIV infection (aOR: 8.27; 95% CI: 1.18–57.69) were associated with higher odds of leukoplakia in VIA-screened women. Conclusion: Leukoplakia can be clinically important without coexistence with acetowhitening. The association of leukoplakia with hrHPV and HIV, coupled with a high referral default and logistical barriers to biopsy and histopathology, calls for simplified management protocols and point-of-care triage tools for cervical screening in low-resource settings.

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Cite

BibTeXRIS
BibTeX
@article{effah2026cervical,
  title = {{Cervical leukoplakia in Ghana: Unveiling diagnostic challenges and informing low-resource screening strategies}},
  author = {Kofi Effah and Ethel Tekpor and Maxwell Afetor and Joseph Emmanuel Amuah and Comfort Mawusi Wormenor and Annita Edinam Dugbazah and Stephen Danyo and Seyram Kemawor and Edna Sesenu and Christopher Nyamekye and Emmanuel Timmy Donkoh and Chrysantus Kubio and Kofi Adum-Attah},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0345847},
  url = {https://doi.org/10.1371/journal.pone.0345847},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Cervical leukoplakia in Ghana: Unveiling diagnostic challenges and informing low-resource screening strategies
AU  - Kofi Effah
AU  - Ethel Tekpor
AU  - Maxwell Afetor
AU  - Joseph Emmanuel Amuah
AU  - Comfort Mawusi Wormenor
AU  - Annita Edinam Dugbazah
AU  - Stephen Danyo
AU  - Seyram Kemawor
AU  - Edna Sesenu
AU  - Christopher Nyamekye
AU  - Emmanuel Timmy Donkoh
AU  - Chrysantus Kubio
AU  - Kofi Adum-Attah
PY  - 2026
DA  - 2026/09/09
JO  - PLOS One
DO  - 10.1371/journal.pone.0345847
UR  - https://doi.org/10.1371/journal.pone.0345847
AB  - Background: Visual Inspection with Acetic acid (VIA) is widely used for detecting cervical (pre)cancer in resource-limited settings due to its simplicity and cost-effectiveness. However, the finding of cervical leukoplakia, poses diagnostic challenges. Methods: This retrospective observational study evaluated the prevalence, associated risk factors, and referral outcomes of cervical leukoplakia among 13,861 women previously screened for cervical cancer in Ghana between June 2016 and May 2024. Screening approaches included VIA alone, mobile colposcopy alone, or VIA/mobile colposcopy combined with other tests (HPV DNA testing and/or cytology). Results: Among 120 women (0.9%) with leukoplakia, 112 (93.3%) did not have acetowhitening on VIA/mobile colposcopy, and 21 (17.5%) received LEEP. The histopathology results ranged from no Cervical Intraepithelial Neoplasia (CIN) (15) to CIN I (2), CIN II (1), and CIN III (3). High-risk HPV positivity (aOR: 30.27; 95% CI: 3.56–257.37) and HIV infection (aOR: 8.27; 95% CI: 1.18–57.69) were associated with higher odds of leukoplakia in VIA-screened women. Conclusion: Leukoplakia can be clinically important without coexistence with acetowhitening. The association of leukoplakia with hrHPV and HIV, coupled with a high referral default and logistical barriers to biopsy and histopathology, calls for simplified management protocols and point-of-care triage tools for cervical screening in low-resource settings.
SN  - 1932-6203
ER  -