Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa

Sankaranarayanan, Rengaswamy; Basu, Parthasarathy; Wesley, Ramani; Mahe, C�dric; Keita, Namory; Mbalawa, Charles C. Gombe; Sharma, R. S.; Dolo, A; Shastri, Surendra S.; Nacoulma, Marius; Nayama, M.; Somanathan, Thara; Lucas, Eric; Muwonge, Richard; Frappart, Lucien; Parkin, Donald Maxwell

doi:10.1002/ijc.20190

Cited by 272 publications

(300 citation statements)

References 33 publications

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“…Reportedly, VIA has a higher sensitivity but lower specificity than that of cytology in developing countries. 5,7 The lower specificity implies a higher number of women requiring additional investigation=treatment, as shown in our study. Concerns have been expressed about the reproducibility and quality control of VIA in field conditions.…”

Section: Discussionsupporting

confidence: 63%

“…18 It is obvious that VIA leads to an excess detection of low-grade abnormalities, due to the naked eye-detectable acetowhitening of lesions. 7,19 Test-positive women in the VIA arm had higher compliance with colposcopy as it was performed in the field immediately after screening. The low frequency of inconclusive colposcopy in VIA-positive women is not surprising as VIA essentially detects lesions on the ectocervix close to the SCJ or the external os and, thus, the SCJ is visible in almost all VIA-positive women.…”

Section: Discussionmentioning

confidence: 99%

“…7,12 Observation of a well-defined, opaque acetowhite area close to the SCJ or dense acetowhitening of a cervical growth constituted a positive VIA test. VIA-negative women were reassured, and medication was prescribed if they suffered from cervical inflammation.…”

Section: Screening In the Fieldmentioning

confidence: 99%

“…Its accuracy at detecting cervical neoplasia has been extensively studied and found to be satisfactory. [5][6][7] The role of persistent infection with oncogenic types of HPV in the etiology of cervical cancer has encouraged the evaluation of HPV testing as a screening tool. [8][9][10] The ultimate proof of efficacy of a screening test for cervical neoplasia is its ability to prevent invasive cancer when implemented in a program setting.…”

mentioning

confidence: 99%

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A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India

Sankaranarayanan

Nene

Dinshaw

et al. 2005

Intl Journal of Cancer

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179

142

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The impact of screening by visual inspection with acetic acid (VIA), cytology or HPV testing on cervical cancer incidence and mortality is investigated in a cluster randomized controlled trial in India. We report findings after the screening phase, when 52 clusters, with a total of 142,701 women aged 30-59 years in Osmanabad District, India, were randomized into 4 arms for a single round of screening by trained midwives with either VIA, cytology or HPV testing as well as a control group. All laboratory tests were done locally. Test-positive women underwent investigations (colposcopy=biopsy) and treatment in the base hospital. Data on participation, test positivity, positive predictive value and detection rates of cervical neoplasia were analyzed using cluster design methodology. Of the eligible women, 72-74% were screened. Test positivity rates were 14.0% for VIA, 7.0% for cytology and 10.3% for HPV. The detection rate of high-grade lesions was similar in all intervention arms (0.7% for VIA, 1.0% for cytology and 0.9% for HPV testing) (p 5 0.06, Mann-Whitney test). While the detection rate for VIA dropped to 0.5% with declining test positivity during the course of the study, it remained constant for cytology and HPV testing. Over 85% of women with high-grade lesions received treatment. Our results show that a high level of participation and good-quality cytology can be achieved in low-resource settings. VIA is a useful alternative but requires careful monitoring. Detection rates obtained by HPV testing were similar to cytology, despite higher investments. ' 2005 Wiley-Liss, Inc.Key words: visual inspection with acetic acid; cytology; human papillomavirus testing; cervical cancer; screening Cervical cancer is an important public health problem of adult women in many developing countries. 1,2 Cytology screening programs have resulted in a marked decline of this disease in developed countries. 2 However, the considerable financial, technical and logistic inputs necessary for effective cytology programs means that the results obtained in developing countries have been, at best, mediocre. 3,4 Hence, it is important to evaluate the effectiveness of alternative methods of screening, such as VIA and HPV testing, that may be more readily implemented in different settings.VIA is simple and inexpensive and can be provided by midwives, nurses and other HWs. Its accuracy at detecting cervical neoplasia has been extensively studied and found to be satisfactory. [5][6][7] The role of persistent infection with oncogenic types of HPV in the etiology of cervical cancer has encouraged the evaluation of HPV testing as a screening tool. [8][9][10] The ultimate proof of efficacy of a screening test for cervical neoplasia is its ability to prevent invasive cancer when implemented in a program setting. Whether a screening program using VIA or HPV testing will be followed by a reduction in disease burden and the cost-effectiveness of these alternate approaches based on real program-based information remain to be established. These appro...

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Screening In the Fieldmentioning

confidence: 99%

mentioning

confidence: 99%

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A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India

Sankaranarayanan

Nene

Dinshaw

et al. 2005

Intl Journal of Cancer

Self Cite

179

142

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“…These include techniques for testing and treatment of precancerous lesions in a single visit, using "direct visualization" (either visualization with coloration with acetic acid [VIA] or with Lugol's iodine [VILI]). These techniques have been piloted in trials in LMICs, with positive results 14 . The treatment (for women without advanced disease) is by cryotherapy -freezing of abnormal tissue.…”

Section: The Challenge Of Cervical Cancer Screening In Low and Middlementioning

confidence: 99%

Cervical cancer screening: barriers to access and potential solutions for Nigeria

Akwaowo¹,

Vanni²

2015

cbr

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In developed countries, giant strides have been made in reducing mortality due to cervical cancer. The success recorded has been largely attributed to effective screening programmes. In contrast, the burden and mortality due to this disease is rising in developing countries. Access to screening services remains a major challenge for the majority of the population at risk. This paper reviews the current demand-side barriers to cervical cancer screening in Nigeria and identifies potential solutions. Using academic databases and grey literature, a review was carried out to identify current screening modalities, barriers to access, and potential solutions. The current innovative method for control is early detection and treatment using "See and Treat" which involves visual inspection of the cervix with acetic acid (VIA) and cryotherapy. Lack of awareness, cost, and availability were identified as major barriers to access. Potential solutions feasible in the Nigerian context were categorized as financial and non-financial. The potential financial interventions include voucher schemes, conditional cash transfers, health equity, community loan funds, and prepayment mechanisms. Potential non-financial interventions that would be useful include raising awareness via health education and counseling, community participation, community based interventions, and pre-payment mechanisms.

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Screen-and-Treat Approaches for Cervical Cancer Prevention in Low-Resource Settings

Denny¹,

Kuhn²,

Souza³

et al. 2005

JAMA

310

261

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ACH YEAR 471 000 CASES AND 233 000 deaths occur from cervical cancer worldwide, of which 80% occur in less-developed countries that have access to less than 5% of global cancer treatment resources. 1 The lifetime risk of a woman developing cervical cancer in a lowresource setting is approximately 2% to 4%. [2][3][4] Cytology-based screening programs have markedly reduced the incidence of cervical cancer in developed countries that have the infrastructure to support these programs. 5 However, screening programs have proven difficult to implement in low-resource settings. There are 2 predominant reasons why cytology-based programs have proven difficult to implement and sustain in low-resource settings. One is the nature of the screening test. 6 Highquality cytology laboratories are difficult to maintain and there are often substantial delays before the results become available. 7 Another is the extensive workup that is typically used for women with abnormal cytological results. In developed countries, women with abnor-

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Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa

Cited by 272 publications

References 33 publications

A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India

A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India

Cervical cancer screening: barriers to access and potential solutions for Nigeria

Screen-and-Treat Approaches for Cervical Cancer Prevention in Low-Resource Settings

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