Comparison between Visual Inspection Using Acetic Acid and Papanicolaou Smear in Cervical Cancer Screening in A Nigerian Sub-Rural Population - (Pages 24-33)
Mojeed Momoh1, Jedidiah Buraimoh Afekhobe1, Reuben Agbons Eifediyi1,Governor Okome1, Joseph Eigbefoh1, Chris Owobu2 and Felix Omorogbe1
1Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria and College of Medicine, Ambrose Alli University, Ekpoma, Edo State, Nigeria; 2Department of Histopathology, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria and College of Medicine, Ambrose Alli University, Ekpoma, Edo State, Nigeria
Background: Cervical cancer is an important reproductive health concern and is the second most common cancer in women worldwide. Poorly organised health delivery system have made high coverage for cervical cancer screening using Papanicolaou smear test in most low and middle income countries difficult to achieve; leading to high cervical cancer death rate. Objective of study is to compare the accuracy of visual inspection of the cervix using 5% acetic acid which World Health Organisation have advocated for low resource countries as an available and affordable alternative, to Papanicolaou smear test as a cervical cancer screening method in a tertiary hospital serving low resource communities.
Materials and Methods: This was a comparative cross sectional study among consenting 300 women aged between 25 and 66 years attending clinics in lrrua Specialist Teaching Hospital (ISTH) and consenting female staffs of the hospital. The accuracy of VIA was compared with Pap smear using histopathology definitive diagnosis reports of biopsied cervical tissue as a reference.
Results: VIA had higher sensitivity and negative predictive value, 93.3% and 94.2%, and lower specificity, positive predictive value and accuracy, 57.6%, 53.8% and 69% respectively compared with Pap smear with sensitivity, NPV, specificity, PPV and accuracy, 66.0%, 84.4%, 94.2%, 85.3% and 84.6% respectively. There was significant difference between VIA and Pap smear accuracy; X2 = 8.667, P value = 0.003 and 95% CI of 0.050 – 0.334.
Conclusion: VIA is an effective complementary or adjunctive cervical cancer screening tool to Pap smear for increased accuracy. It can also be used as a screening alternative in poor resource settings with non availability of Pap smear facility and should be incooperated as a cost effective national cervical cancer screening protocol.
Keywords: HSIL, LSIL, ASCUS, IRRUA, See and Treat Protocol.