Comparison between Visual Inspection Using Acetic Acid and Papanicolaou Smear in Cervical Cancer Screening in A Nigerian Sub-Rural Population
DOI:
https://doi.org/10.20941/2309-4400.2017.05.1Keywords:
HSIL, LSIL, ASCUS, IRRUA, See and Treat Protocol.Abstract
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.
References
Human Papilloma virus and cervical cancer summary report. IARC Globocan 2007; 5-8.
Bosch FX, Munoz N. The viral etiology of cervical cancer. Virus Res 2002; 89: 183-90. https://doi.org/10.1016/S0168-1702(02)00187-9
Paavonen J, Naud P, Salmerón J et al. Efficacy of human papillomavirus (HPV)- 16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): Final analysis of a double-blind, randomised study in young women. Lancet 2009; 374(9686): 301-14. https://doi.org/10.1016/S0140-6736(09)61248-4
Duraisamy K, Jaganathan KS, Bose JC. Methods of detecting cervical cancer. Adv Bio Res 2011; 5: 226-32.
Ghosh P, Gandhi G, Kochhar PK, Zutshi V, Batra S. Visual inspection of cervix with Lugol's iodine for early detection of premalignant & malignant lesions of cervix. Indian J Med Res 2012; 136(2): 265-71.
Khan MA, Raja FY, Ishfaq G et al. PAP screening for precancerous conditions of the cervical cancer. Pak J Med Res 2005; 44: 111-13.
Goldie SJ, Gaffikin L, Goldhaber-Fiebert JD et al. Cost effectiveness of cervical cancer screening in five developing Countries. ACCP Cost Working Group. N Engl J Med 2005; 353(20): 2158-68. https://doi.org/10.1056/NEJMsa044278
Sherris J, Wittet S, Kleine A et al. Evidence based, alternative cervical cancer screening approaches in low resource settings. Int Perspect Sex Reprod Health 2009; 35(3): 147-54. https://doi.org/10.1363/3514709
Bhatla N, Mulchopadhyay A, Kriplani A, Pandey RM. Evaluation of adjunctive tests for cervical cancer screening in low resource settings. Indian J Cancer 2007; 44: 51-5. https://doi.org/10.4103/0019-509X.35811
Rana T, Zia A, Sher S. Comparative evaluation of Pap-smear and VIA in cervical cancer screening programme in LWH, Lahore. Special Edition Ann 2010; 16: 104-7.
Sankaranarayanan R, Nene BM, Shastri SS et al. HPV screening for cervical cancer in rural India. N Engl J Med 2009; 360(14): 1385-94. https://doi.org/10.1056/NEJMoa0808516
Mabeya H, Khozaim K, Liu T et al. Comparison of conventional cervical cytology versus visual inspection with acetic acid among human immunodeficiency virus infected women in Western Kenya. J Low Genit Tract Dis 2012; 16(2): 92-7. https://doi.org/10.1097/LGT.0b013e3182320f0c
Program for Appropriate Technology in Health, Cervical cancer Prevention; Summer Edition. RHO 2003.
Sankaranarayanan R, Esmy PO, Rajkumar R 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. https://doi.org/10.1016/S0140-6736(07)61195-7
Aswathy S, Mariya AQ, Beteena K, Leelamoni K. Cervical cancer screening: current knowledge & practice among women in a rural population of Kerala, India. Indian J Med Res 2012; 136(2): 205-10.
Denny L, kuhn L, Michelle DS et al. Screen and treat approaches for cervical cancer prevention in low resource settings: a randomized controlled trial. J Am Med Assoc 2005; 294(17): 2173-81. https://doi.org/10.1001/jama.294.17.2173
Singh KN, More S. Visual inspection of cervix with acetic acid in early diagnosis of cervical intra-epithelial neoplasia and early cancer cervix. J Obstet Gynecol India 2010; 60(1): 55-60. https://doi.org/10.1007/s13224-010-0010-7
Ahmed I, Arja R and Vibeke R. Cervical cancer screening in primary health care setting in Sudan: a comparative study of VIA and Pap smear. Int J Women's Health 2012; 4: 67-73.
Israel GD. Determining sample size. University of Florida, institute for Food and Agricultural Sciences. Jul 20, 2012
Denny L, Kuhn L, Pollack A, Wainwright H and Wright T. Evaluation of alternative methods of cervical cancer screening in resource poor settings. Cancer 2000; 89: 826-33. https://doi.org/10.1002/1097-0142(20000815)89:43.0.CO;2-5
Belinson J, Pretorius R, Zhang W et al. Cervical cancer screening by simple visual inspection after acetic acid. Obstet Gynaecol 2001; 98: 441-4.
Sankaranarayanan R, Rajkumar R, Theresa R et al. Initial result from a randomised trial of cervical visual screening in rural south India. Int J Cancer 2004 Apr; 109(3): 461-7. https://doi.org/10.1002/ijc.11726
Wright TC, Denny L, Kuhn L, Goldie S. Use of visual screening methods for cervical cancer screening. Obstet Gynecol Clin North Am 2002; 29: 701-34. https://doi.org/10.1016/S0889-8545(02)00045-1
Doh AS, Nkele NN, Achu P, Essimbi F, Essame O, Nkegoum B. Visual inspection with Acetic acid and cytology as screening methods for cervical lesions in Cameroon, International Journal of Gynecology and Obstetrics 2005; 89: 167-73. https://doi.org/10.1016/j.ijgo.2004.12.040
Sankaranarayanan R, Esmy PO, Rajkumar R 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. https://doi.org/10.1016/S0140-6736(07)61195-7
Schwebke JR, Zajackowski ME. Effect of concurrent lower genital infection and cervical cancer screening. Genitourin Med 1997; 73: 383. https://doi.org/10.1136/sti.73.5.383
Singh KN, More S. Visual inspection of cervix with acetic acid in early diagnosis of cervical intra epithelial neoplasia and early cancer cervix. J Obstet Gynaecol India 2010; 60: 55-60. https://doi.org/10.1007/s13224-010-0010-7
Methasinee P, Kamol P, Siriwan T et al. Visual inspection with acetic acid for detection of grade lesion in atypical squamous cells and low grade squamous intra epithelial lesions from cervical Pap smear. J Gynecol Oncol 2011; 22(3): 145-51. https://doi.org/10.3802/jgo.2011.22.3.145
Neha Gami, Gauri Gandhi, Swaraj Batra, Vijay Zutshi, Das BC, Suresh Bhambhani. Role of visual inspection of cervix with acetic acid and high risk human papilloma virus DNA testing in screening for cervical cancer. Int J Reprod Contracept Obstet Gynecol 2013; 2(2): 152-6. https://doi.org/10.5455/2320-1770.ijrcog20130608
