Comparison of visual inspection and Papanicolau (PAP) smears for cervical cancer screening in Honduras: should PAP smears be abandoned?

Abstract

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.

Cervical cancer screening in primary health care setting in Sudan: a comparative study of visual inspection with acetic acid and Pap smear

“…The result of screened-positive women by VIA in this study (7.6%) was higher than that found in Bangladesh (4.8%)14 and in Angola (6.6%),15 but lower than in Kenya (13.9%)16 or in Honduras (14%),17 and it was much lower than found in El Salvador (26.5%),18 or in Thailand (38.1%) 19…”

Cervical Cancer Prevention in the 21st Century: Cost Is Not the Only Issue

“…A study in Honduras found that among 339 women who had both VIA and a Pap test, 49 VIA examinations were read as abnormal. 7 Of these, 23 had biopsyproven dysplasia. None of the 23 true positive cases was identified when the Pap tests were read in Honduras and only 4 were identified when the slides were reread in the United States.…”

Impact of Patient Adherence and Test Performance on the Cost-Effectiveness of Cervical Cancer Screening in Developing Countries

“…During our community-based screening and treatment project in Honduras (Perkins, Langrish, Stern, Figueroa, & Simon, 2007) we found that factors including lack of communication infrastructure (telephone, postal services), routine supplies (spatulas, fixative, laboratory dyes), and up-to-date cytopathologist training and certification negatively impacted both Pap smear quality and patient adherence. The impact of these local factors may be important when comparing the cost-effectiveness of Pap smear and VIA screening programs.…”