Direct visual inspection for cervical cancer screening

Abstract

BACKGROUNDThe authors evaluated direct visual inspection of the cervix after the application of 5% acetic acid (DVI) as a cervical cancer screening test for use in low‐resource settings.METHODSFour tests were used to screen 2754 previously unscreened women: DVI with and without ×4.5 magnification and differentiating between all lesions and well‐circumscribed lesions; testing for high‐risk types of human papillomavirus DNA using the Hybrid Capture II assay, cervical cytology, and Cervicography™. Women with positive results on any of the four screening tests were referred for colposcopy and histologic sampling. All women were tested for N. gonorrhea, C. trachomatis, T. vaginalis, and human immunodeficiency virus 1.RESULTSHistologically confirmed carcinoma was diagnosed in 21 women (0.8%), high‐grade squamous intraepithelial lesions (SILs) were diagnosed in 96 women (3.5%), and low‐grade SILs were diagnosed in 102 women (3.7%). The estimated sensitivity of DVI when performed without magnification for high‐grade SILs was 70%, with an estimated specificity of 79%. Magnification did not significantly improve sensitivity for high‐grade SILs (74% with magnification) but significantly reduced specificity (77%). Restricting the definition of a positive DVI test to a well‐defined acetowhite lesion reduced sensitivity and significantly improved specificity. Infection with T. vaginalis, N. gonorrhea, and C. trachomatis did not alter sensitivity or specificity.CONCLUSIONSThis study confirmed the utility of DVI as a primary screening test. Evaluation of the clinical effectiveness of screening with this low‐cost and simple test in low‐resource settings is necessary. Cancer 2002;94:1699–707. © 2002 American Cancer Society.DOI 10.1002/cncr.10381

Widening the Cervical Cancer Screening Net in a South African Township: Who Are the Underserved?

“…As discussed above, this is a population of considerable gynecological ill-health with high rates of HIV, HPV, cervical neoplasia, and other sexually transmitted infections (Denny, Kuhn, Pollack, & Wright, 2002). Women in our sample revealed concerns about their own gynaecological problems, with more than half reporting having vaginal problems and one third reporting having "womb" problems in the previous 12 months.…”

“…This is a population of considerable ill-health: Recent prevalence rates for HIV and other sexually transmitted infections were found to be 7% and 25%, respectively, in women aged 35-65 recruited in the Khayelitsha Cervical Cancer Screening Project (KCCSP). Cervical cancer in the same population was 0.8%, and the prevalence of high and low grade squamous intraepithelial lesions was 3.5% and 3.7%, respectively, with 20% positive for high-risk types of the human papilloma virus (HPV) DNA (Denny, Kuhn, Pollack, & Wright, 2002). A study of 659 women in Khayelitsha in [1989][1990] showed that 55% of women had never had a cervical smear .…”

Prevention of cervical cancer

“…The difference between the two scenarios is most likely due to having a system of tracking women with abnormal smears to ensure appropriate followup. Denny et al 40 showed an over 90% return rate post screening in a research setting where intense attention was paid to recording women's contact details, home addresses etc. and women who defaulted were tracked within a week of their missed appointment, suggesting that mechanisms for recalling women with abnormal smears for further investigation and treatment is as essential a part of the structure of a screening programme as is high quality laboratory services.…”

Incidence rate of cervical cancer and precancerous lesions in East Azarbayjan, Iran

“…Screening is sporadic in developing countries and has tended to be opportunistic, with little impact on the incidence of cervical carcinoma. 10 3 Different studies have shown that cervical cancer is an important but hidden health problem in Iran.…”