Screening for cervical carcinoma using visual inspection with acetic acid

Abdel-Hady, El-Said; Emam, Mohammad; Algohary, Ahmad; Hassan, Mohammed; Farag, Mohamed; Abo-Elkheir, M.

doi:10.1016/j.ijgo.2006.01.024

Cited by 18 publications

(8 citation statements)

References 17 publications

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“…5 However, there is some evidence that improved training may reduce this rate. 15 A recent meta-analysis found VIA to have 80% sensitivity (consistent with previous measures at approximately 79% sensitivity) and 92% specificity (an increase from the previously measured 85% specificity) for early detection of cervical cancer.…”

Section: Cervical Cancer Screeningsupporting

confidence: 68%

A Cervical Cancer Screening Trainer for Use in Low-Resource Settings

Young

Kramer

Chu

et al. 2016

IJSLE

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-Each year, cervical cancer causes the death of over 275,000 women worldwide with eighty percent of these cases occurring in low or lower-middle income countries. Cervical cancer screening programs reduce cervical cancer occurrence by identifying and treating pre-cancerous cervical abnormalities before they develop to malignant stages. Standard methods of screening are inappropriate for use in low-resource settings and therefore screening is very limited. Based on a design ethnography study performed over a two-month period in Ghana, a need was identified for a low-fidelity model to assist in training healthcare providers to screen for cervical cancer using visual inspection with acetic acid. The design presented in this paper is a box trainer with a simulated vaginal cavity that allows a user to insert cervical images displayed on plastic tabs or cards from the Jhpiego Visual Inspection of the Cervix Flash Card Set © . A modular electronic feedback mechanism trains the user to properly complete the steps of the screening procedure and to track the successes of their diagnoses. This paper describes the need for a cervical cancer screening trainer, the process used to design a trainer to support visual inspection with acetic acid, and the results of prototyping and preliminary usability tests.Index Terms -Cervical cancer screening, visual inspection with acetic acid, medical training, design ethnography, global health design

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Section: Cervical Cancer Screeningsupporting

confidence: 68%

A Cervical Cancer Screening Trainer for Use in Low-Resource Settings

Young

Kramer

Chu

et al. 2016

IJSLE

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“…The screen positive rate of 18.2% is much higher than rates reported in the literature, which range from 4% -8% in similar patient populations [4,9,23]. This may reflect the small sample size as well as selection bias, in that women with ongoing gynecologic issues were more likely to present at the time the project was initiated.…”

Section: Colposcopymentioning

confidence: 68%

Development of a cervical cancer screening program in a slum setting using visual inspection with acetic acid: Analysis of feasibility and cost

Bradford¹,

Dey²,

Hussain³

et al. 2012

OJOG

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Objective: In Bangladesh, cervical cancer is the second most common cause of cancer deaths in women. Annually, over 50 million women are at risk for cervical cancer, with 17,686 cases diagnosed and 10,362 deaths each year. Visual inspection with acetic acid (VIA) is a well validated tool in low resource areas for identifying cervical lesions. In this pilot study, AK Khan Health Care Trust (AKKHCT), in collaboration with oncologists at Massachusetts General Hospital (LB, BD, AG), launched a VIA cervical cancer-screening program. Methods: A clinic was established in the Korail Slum of Dhaka, a 90-acre slum with over 70,000 inhabitants, in the summer of 2011. From September 17, 2011 to November 1, 2011, ten women living in the Korail Slum were recruited and completed the three-month training program to learn how to do a pelvic examination and to evaluate the cervix using VIA. Three of the ten women performed VIA screening during the study period. Results: 44 patients were recruited and 8 women were identified to have VIA-positive results for a screen-positive rate of 18.2%. Two of the eight women underwent treatment. One woman underwent an excisional procedure for pre-invasive disease in the slum clinic. The other woman had an early invasive cervical cancer and was successfully treated in a local hospital. Conclusion: Our pilot project demonstrates some important factors in developing and implementing a successful screening program. Involving laywomen as healthcare workers provides a strong tie to community, as well as education, economic independence, and empowerment for women who would otherwise occupy a lower social standing in their community. VIA is feasible in the complicated environment of an inner city slum. It was feasible to perform minor excisional procedures to treat pre-invasive cervical disease in the slum clinic

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“…One possibility is publication bias, where only studies with participation nearing the 70% effectiveness threshold report participation. In our review of 21 studies comparing alternative screening methods, the majority (14/21, 67%) did not report participation rates at all [5], [6], [8], [9], [10], [16], [17], [18], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India

et al. 2010

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BackgroundWhile many studies have compared the efficacy of Pap cytology, visual inspection with acetic acid (VIA) and human papillomavirus (HPV) DNA assays for the detection cervical intraepithelial neoplasia and cancer, few have evaluated the program effectiveness.Methods and FindingsA population-based sample of 5603 women from Medchal Mandal in Andhra Pradesh, India were invited to participate in a study comparing Pap cytology, VIA, and HPV DNA screening for the detection of CIN3+. Participation in primary screening and all subsequent follow-up visits was rigorously tracked. A 20% random sample of all women screened, in addition to all women with a positive screening test result underwent colposcopy with directed biopsy for final diagnosis. Sensitivity, specificity, positive and negative predictive values were adjusted for verification bias. HPV testing had a higher sensitivity (100%) and specificity (90.6%) compared to Pap cytology (sensitivity = 78.2%; specificity = 86.0%) and VIA (sensitivity = 31.6%; specificity = 87.5%). Since 58% of the sample refused involvement and another 28% refused colposcopy or biopsy, we estimated that potentially 87.6% of the total underlying cases of CIN3 and cancer may have been missed due to program failures.ConclusionsWe conclude that despite our use of available resources, infrastructure, and guidelines for cervical cancer screening implementation in resource limited areas, community participation and non-compliance remain the major obstacles to successful reduction in cervical cancer mortality in this Indian population. HPV DNA testing was both more sensitive and specific than Pap cytology and VIA. The use of a less invasive and more user-friendly primary screening strategy (such as self-collected swabs for HPV DNA testing) may be required to achieve the coverage necessary for effective reduction in cervical cancer mortality.

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Screening for cervical carcinoma using visual inspection with acetic acid

Abstract: Visual inspection with acetic acid, although associated with a relatively high rate of false-positive results, is a valuable test for the screening of cervical carcinoma.

Cited by 18 publications

References 17 publications

A Cervical Cancer Screening Trainer for Use in Low-Resource Settings

A Cervical Cancer Screening Trainer for Use in Low-Resource Settings

Development of a cervical cancer screening program in a slum setting using visual inspection with acetic acid: Analysis of feasibility and cost

Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India

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