Performance of visual inspection of the cervix with acetic acid (<scp>VIA</scp>) for triage of <scp>HPV</scp> screen‐positive women: results from the <scp>ESTAMPA</scp> study

Baena, Armando; Mesher, David; Salgado, Yuli; Martínez, Sandra; Villalba, Griselda; Amarilla, Maria Luisa; Salgado, Brenda; Flores, Bettsy; Bellido‐Fuentes, Yenny; Álvarez‐Larraondo, Manuel; Valls, Joan; Lora, Oscar; Virreira‐Prout, Gonzalo; Figueroa, Jacqueline; Turcios, Elmer; Soilán, Ana María; Ortega, Marina; Celis, Marcela; González, Mauricio; Venegas, Gino; Terán, Carolina; Ferrera, Annabelle; Torres, Laura Patricia Mendoza; Kasamatsu, Elena; Murillo, Raúl; Wiesner, Carolina; Broutet, Nathalie; Luciani, Silvana; Herrero, Rolando; Almonte, Maribel

doi:10.1002/ijc.34384

Cited by 11 publications

(18 citation statements)

References 43 publications

(85 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When the cohort is stratified by age groups, we refer to the large European population-based screening studies, which offer a more comprehensive categorization of age groups in 5-year intervals . Our analysis revealed that triage with visual inspection exhibited a higher detection rate of CIN2+ cases among younger women, which was consistent with previous studies using visual inspection, genotyping, or cytology for HPV-positive triage . This phenomenon could be associated with the retreat of the squamocolumnar junction and the resulting challenges in visualizing endocervical disease in postmenopausal women .…”

Section: Discussionsupporting

confidence: 84%

“…Our results suggest that visual inspection may serve as an optional triage test among women whose results of the careHPV test were positive. In comparison with a multicenter, randomized clinical trial conducted in rural China in 2015, visual inspection demonstrated a lower positivity rate (18.3% vs 27.1%), which can be attributed to the subjective diagnosis by different physicians . Meanwhile, a greater detection rate of CIN2+ (2.8% vs 0.5%) and a significant reduction in the number of colposcopy referrals needed to identify 1 case of CIN2+ (4.2 vs 8.0) were observed in our study.…”

Section: Discussioncontrasting

confidence: 52%

“…In comparison with a multicenter, randomized clinical trial conducted in rural China in 2015, 22 visual inspection demonstrated a lower positivity rate (18.3% vs 27.1%), which can be attributed to the subjective diagnosis by different physicians. 12,23 Meanwhile, a greater detection rate of CIN2+ (2.8% vs 0.5%) and a significant reduction in the number of colposcopy referrals needed to identify 1 case of CIN2+ (4.2 vs 8.0) were observed in our study. These findings highlight the screening efficiency in the practical setting.…”

Section: Performance Of Visual Inspection Triage Of Hpv-positive Womensupporting

confidence: 53%

“…Currently, the performance of visual inspection with acetic acid triage among large samples of HPV-positive women has limited supporting evidence. 12,13 In 2009, a government-led pilot program for cervical cancer screening was initiated in 221 counties in rural China. The program was included in the basic public health services project and expanded to cover the entire female population aged 35 to 64 years in 2019.…”

Section: Introductionmentioning

confidence: 99%

“…Visual inspection with acetic acid offers several advantages, including affordability, ease of use, immediate results, and reduced need for recall rounds. Currently, the performance of visual inspection with acetic acid triage among large samples of HPV-positive women has limited supporting evidence …”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Cervical Cancer Screening via Visual Inspection With Acetic Acid and Lugol Iodine for Triage of HPV-Positive Women

Wang,

Dang,

Liu

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceLimited evidence supports the performance of human papillomavirus (HPV) DNA testing as a primary screening method, followed by triage with visual inspection with acetic acid, in areas with limited health care resources, as suggested by the 2021 World Health Organization guidelines.ObjectiveTo evaluate the performance of visual inspection with acetic acid and Lugol iodine as a triage method for detecting cervical precancerous lesions among HPV-positive women in 1 visit.Design, Setting, and ParticipantsThis cohort study examined the implementation of a government-led cervical cancer screening program conducted from January 1, 2016, to December 31, 2020, in Ordos City, China. Female residents, aged 35 to 64 years, who understood the screening procedures and voluntarily participated were included in the study. Women were excluded if they reported never having had sexual intercourse, were pregnant, had a hysterectomy, or had ever undergone treatment for cervical lesions. Statistical analysis was conducted from December 2022 to December 2023.ExposuresThe program used the careHPV DNA assay as the primary screening method, and immediate triage was performed by visual inspection if HPV screening results were positive, with a 5-year screening interval. A colposcopy was performed for the women who had suspected cancer on visual inspection results or who were HPV positive and had abnormal visual inspection results, all in 1 visit.Main Outcomes and MeasuresThe rate of compliance with colposcopy and the detection rate of cervical intraepithelial neoplasia grade 2 or higher (CIN2+).ResultsThe study included 187 863 women (median age, 46 years [IQR, 40-52 years]) who participated in the program and had valid HPV test results. The overall prevalence of HPV positivity was 12.8% (24 070 of 187 863), and the adherence to triage with visual inspection among HPV-positive women was 93.9% (22 592 of 24 070). Among HPV-positive women, the rate of compliance with colposcopy was 65.6% (2714 of 4137), and the CIN2+ detection rate was 2.8% (643 of 22 592).Conclusions and RelevanceThe findings of this cohort study suggest that the implementation of HPV testing, visual inspection, and colposcopy within 1 visit may mitigate losses to follow-up, detect precancerous lesions, and hold significant implications for screening in comparable areas with limited health care resources.

show abstract

Section: Discussionsupporting

confidence: 84%

Section: Discussioncontrasting

confidence: 52%

Section: Performance Of Visual Inspection Triage Of Hpv-positive Womensupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Cervical Cancer Screening via Visual Inspection With Acetic Acid and Lugol Iodine for Triage of HPV-Positive Women

Wang,

Dang,

Liu

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

Performance of visual inspection of the cervix with acetic acid (VIA) for triage of HPV screen‐positive women: results from the ESTAMPA study

Baena

Mesher

Salgado

et al. 2022

Intl Journal of Cancer

View full text Add to dashboard Cite

Abbreviations: AI, artificial intelligence; ASC-US, atypical squamous cells of undetermined significance; CI, confidence interval; CIN, cervical intraepithelial neoplasia; cNPV, complement of the negative predictive value; ESTAMPA, EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano (Spanish acronym); GP, general practitioner; HPV, human papillomavirus; HSIL, high-grade squamous intraepithelial lesion; IARC,

show abstract

Field experience with the 8‐HPV‐type oncoprotein test for cervical cancer screening among HPV‐positive women living with and without HIV in LMICs

Downham,

Rol,

Forestier

et al. 2024

Intl Journal of Cancer

Self Cite

View full text Add to dashboard Cite

Overexpression of HPV‐oncoproteins E6 and E7 is necessary for HPV‐driven cervical carcinogenesis. Hence, these oncoproteins are promising disease‐specific biomarkers. We assessed the technical and operational characteristics of the 8‐HPV‐type OncoE6/E7 Cervical Test in different laboratories using cervical samples from HPV‐positive women living with (WLWH) and without HIV. The 8‐HPV‐type OncoE6/E7 Test (for short: “OncoE6/E7 test”) was performed in 2833 HIV‐negative women and 241 WLWH attending multicentric studies in Latin America (ESTAMPA study), and in Africa (CESTA study). Oncoprotein positivity were evaluated at each testing site, according to HIV status as well as type‐specific agreement with HPV‐DNA results. A feedback questionnaire was given to the operators performing the oncoprotein test to evaluate their impression and acceptability regarding the test. The OncoE6/E7 test revealed a high positivity rate heterogeneity across all testing sites (I2: 95.8%, p < .01) with significant lower positivity in WLWH compared to HIV‐negative women (12% vs 25%, p < .01). A similar HPV‐type distribution was found between HPV DNA genotyping and oncoprotein testing except for HPV31 and 33 (moderate agreement, k = 0.57). Twenty‐one laboratory technicians were trained on oncoprotein testing. Despite operators' concerns about the time‐consuming procedure and perceived need for moderate laboratory experience, they reported the OncoE6/E7 test as easy to perform and user‐friendly for deployment in resource‐limited settings. The high positivity rate variability found across studies and subjectivity in test outcome interpretation could potentially results in oncoprotein false positive/negative, and thus the need for further refinements before implementation of the oncoprotein testing in screen‐triage‐and‐treat approaches is warranted.

show abstract

Performance of visual inspection of the cervix with acetic acid (VIA) for triage of HPV screen‐positive women: results from the ESTAMPA study

Cited by 11 publications

References 43 publications

Cervical Cancer Screening via Visual Inspection With Acetic Acid and Lugol Iodine for Triage of HPV-Positive Women

Cervical Cancer Screening via Visual Inspection With Acetic Acid and Lugol Iodine for Triage of HPV-Positive Women

Performance of visual inspection of the cervix with acetic acid (VIA) for triage of HPV screen‐positive women: results from the ESTAMPA study

Field experience with the 8‐HPV‐type oncoprotein test for cervical cancer screening among HPV‐positive women living with and without HIV in LMICs

Contact Info

Product

Resources

About