DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20160578

Visual inspection with acetic acid for cervical cancer screening in a tertiary health care centre

Shaily Agarwal, Renu Gupta, Apurva Agarwal, Apurva Agarwal, Kiran Pandey, Neena Gupta, Arti Katiyar

Abstract


Background: Cervical cancer is one of the most prevalent malignant neoplasms among women in developing countries. Invasive cervical cancer is preceded by a long premalignant phase known as cervical intraepithelial neoplasia (CIN). The goal of cervical cancer screening is the detection and treatment of precancereous lesions before cancer develops. The objective of the study was to assess visual inspection with acetic acid (VIA) as a screening tool for use in a well-equipped health center , to evaluate VIA as an alternative or adjunct to the Papanicolaou (Pap) smear, and to determine if VIA can play a role in settings other than low resource ones.

Methods: This was a prospective study of 1520 asymptomatic women, carried out in 2014-2015. The study was performed at a tertiary care center equipped with the latest-generation technology and highly trained oncologists. The women underwent a complete clinical evaluation, including a Pap smear and VIA. Participants with any positive test were referred for colposcopy and biopsy.

Results: More women tested positive by VIA than on the Pap smear (6.9% vs. 4.2%; P =0.0001). There were 27 women with histologic cervical intraepithelial neoplasia grade 1 (CIN1); of these, 12 were detected by Pap and 15 by VIA (P = 0.4). A diagnosis of CIN 2 or 3 (CIN2–3) was confirmed in a total of 11 cases; Pap detected 4 of the cases and VIA 9 of the cases (P = 0.06). The positive predictive value for detection of CIN 2+ was 8.5% for VIA and 6.2% for Pap (P = 0.5). Most importantly, while only 2.8% of patients with a positive VIA were lost to follow-up before colposcopy that was true for 26.5% of the women with a positive Pap smear (P < 0.0001).

Conclusions: VIA is useful for detection of precursor lesions of cervical cancer not only in low-resource settings but also in well-equipped health centers and cancer centers. In these non low-resource settings, VIA has a positive predictive value comparable to the conventional Pap smear, but it is more likely to achieve earlier diagnosis, follow-up, and treatment than cytology based screening.

Keywords


Cervix neoplasms, Acetic acid, Diagnostic techniques and procedure

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References


Human Papillomavirus and Related Diseases Report INDIA Version posted on www.hpvcentre.net in March 20th. 2015.

Schiffman M, Kjaer SK. Chapter 2: natural history of anogenital human papillomavirus infection and neoplasia. J Natl Cancer Inst Monogr. 2003;(31):14-9.

Mahmoobeh S, Diane S, Philip EC. Cervical cancer prevention:Cervical screening, science in evolution. Obstet Gynecol Clin N Am. 2007;34:739-60.

Sehgal A. Human papilloma virus (HPV) and screening strategies for cervical cancer. Indian journal of Med Res. 2009;130:234-40.

Sangwa LG, Salaheddin M. Visual inspection as a cervical cancer screening method in a primary health care setting in Africa. International Journal of Cancer. 2006;119:1389-95.

Gage JC, Ferreccio C, Gonzales M, Arroyo R, Huivin M, Robles SC. Follow-up care of women with an abnormal cytology in a low resource setting. Cancer Detect Prev. 2003;27(6):466-713.

WHO Comprehensive cervical cancer prevention and control – a healthier future for girls andwomen. http://www.who.int/reproductivehealth/publications/cancers/9789241505147/en/(accessed27 Mar2014)

Apgar BS, Zoschnik L, Wright TC. The 2001Bethesda System terminology.Am Fam Physician. 2003;68:1992-8.

Wright TC, Schiffman M, Solomon D, Cox JT, Garcia F, Goldie S. Interim guidance for the use of human papillomavirus DNA testing as an adjunct to cervical cytology for screening. Obstet Gynecol. 2004;103(2):304-9.

Cronje HS. Screening for cervical cancer in developing countries. Int J Gynaecol Obstet. 2004;84(2):101-8.

Jeronimo J, Castle PE, Herrero R, Burk RD, Schiffman M. HPV testing and visual inspection for cervical cancer screening in resourcepoor regions. Int J Gynaecol Obstet. 2003;83(3):311-3.

Bhatla N, Mukhopadhyay A, Joshi S. Visual inspection for cervical cancer screening; evaluation by doctor versus paramedical worker. Indian Journal of Cancer. 2004;41:32-6.

Blumenthal PD, Lauterbach TM, Sellar JW, Sankarnarayanan R. Training for cervical cancer prevention program in low resource setting; focus on VIA and cryotherapy; International Journal of Gynaecology and Obstetrics. 2005;89:30-7.

Sankaranarayanan R, Budukh AM, Rajkumar R. Effective screening programmes for cervical cancer in low and middle income developing countries. Bull World Heal Organ. 2001;79:954-62.

Sankaranarayanan R, Esmy PO, Rajkumar R, Muwonge R, Swaminathan R, Shanthakumari S, et al. Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster -randomized trial, Lancet. 2007; 370:398- 406.