A critical assessment of screening methods for cervical neoplasia

Abstract

The objective of cervical cancer screening is to reduce cervical cancer incidence and mortality by detecting and treating precancerous lesions. Conventional cytology is the most widely used cervical cancer screening test. Although cytology has been effective in reducing the incidence of and mortality from cervical cancer in developed countries in both opportunistic and--more dramatically--organized national programs, it has been less successful and largely ineffective in reducing disease burden in low-resource settings where it has been implemented. Liquid-based cytology, testing for infection with oncogenic types of human papillomaviruses, visual inspection with 3-5% acetic acid, magnified visual inspection with acetic acid, and visual inspection with Lugol's iodine have been evaluated as alternative tests. Their test characteristics, and the applications and limitations in screening, are discussed with an emphasis on the work of the Alliance for Cervical Cancer Prevention over the past 5 years.

Accuracy of Visual Inspection with Acetic acid in Detecting High-Grade Cervical Intraepithelial Neoplasia in Pre- and Post-Menopausal Thai Women with Minor Cervical Cytological Abnormalities

“…The sensitivity of VIA testing in detecting highgrade CIN and cervical cancer ranged from 67-79% and the specificity varied from 49-86% in previous crosssectional studies which used VIA testing as a primary screening test (Denny et al, 2002;Cronje et al, 2003;Sankaranarayanan et al, 2004;Sankaranarayanan et al, 2005). Our study demonstrated overall sensitivity and specificity of 59.4% and 76.2%, respectively of VIA testing in detecting high-grade CIN in women with minor cervical cytological abnormalities.…”

Making the case for cervical cancer prevention: what about equity?

“…46,47 In a study of nearly 80,000 women in India aged 30-59 screened with VIA, there was a 25% reduction in cervical cancer incidence and 35% reduction in cancer deaths, as compared to a control group that was not screened. Benefits were most marked for women in their 30s.…”

Cervical cancer screening programme in Limpopo province: January 2007 to December 2010

“…24 Several issues have been cited to explain the low coverage rates, including lack of awareness among the target population; inadequate trained personnel to perform the screening tests, read smears and interpret the results; poor communication between the screening sites and laboratories; and inaccessibility of the facilities to diagnose and treat patients who have been detected through the screening process. 25,26 In addition, population-based surveys, conducted in settings similar to those in South Africa, have reported gross inequalities in screening coverage. 27 The women who are at highest risk of developing cervical cancer are among the least likely to be screened.…”