In developing countries, inexpensive, community-based educational programs using radio broadcasts and lecture presentations can increase cervical cancer knowledge and improve screening behavior.

Objective-We examined the impact of patient adherence and screening test performance on the cost-effectiveness of visual inspection with acetic acid (VIA) and Pap smears when used with colposcopy for diagnosis.Materials and Methods-Cost-effectiveness analysis was performed using computer modeling. The primary outcome was cancer prevalence in the ten years following screening. Three hypothetical populations of 35-year-old women were compared: never-screened women, women screened with VIA, and women screened with Pap smears. We used community-based data from our screening program in Honduras to estimate screening test sensitivity and specificity, adherence to follow-up, and costs of screening and colposcopy services. Published data were used to model disease outcomes.Results-VIA was more sensitive than Pap smears (70% vs. 4%), less expensive (U.S. $0.23 vs. $3.17), and the 2-vist VIA system had a higher rate of adherence to follow-up than the 3-visit Pap smear system (84% vs. 38%). VIA had a higher false positive rate than Pap smears resulting in higher colposcopy referral rates, but more dysplasia was detected and treated. Cost-effectiveness analysis revealed that screening with VIA would cost U.S. $3,198 per cancer case avoided and reduce cancer cases by 42%, versus U.S. $36,802 and 2% for Pap screening. Although Pap smear quality was low

Summaryobjective To compare visual inspection with acetic acid (VIA) to Papanicolau (PAP) smears in a community setting in a developing nation.methods Women undergoing cervical cancer screening in Honduras received either VIA and PAP smears (VIA ⁄ PAP group) or PAP smears alone (PAP-only group). Local healthcare providers performed PAP screening. A VIA-trained nurse performed VIA exams. All PAP smears were processed in Honduras. PAP smears from the VIA ⁄ PAP group were reviewed in the United States. Women with positive VIA or PAP tests were offered colposcopy. We compared the relative accuracy of PAP smears and VIA and the proportions of women completing follow-up colposcopy after positive screening tests.results In total, 1709 PAP smears were performed including women from both the VIA ⁄ PAP and PAPonly groups. Nine PAP smears were positive (0.5%). Three women completed colposcopy (33%). All three had biopsy-confirmed dysplasia. In the VIA ⁄ PAP group (n = 339), 49 VIA exams were abnormal (14%) and two PAP smears were abnormal when read in Honduras (0.6%). When reviewed in the United States, 14 of the 339 PAP smears were abnormal (4%). Forty women (83%) completed follow-up colposcopy after a positive VIA exam. Twenty-three had biopsy-proven dysplasia. All 23 dysplasia cases had negative PAP smear readings in Honduras; four PAP smears were reclassified as positive in the United States.conclusions Although few developing countries can maintain high-quality PAP smear programmes, many governments and charitable organizations support cervical cancer screening programmes that rely on PAP smears. This study underscores the need to promote alternative technologies for cervical cancer screening in low-resource settings.