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Gaffikin L, Blumenthal PD, Emerson M, Limpaphayom K. Safety, acceptability, and feasibility of a single-visit approach to cervical-cancer prevention in rural Thailand: a demonstration project. Lancet 2003; 361:814-20. [PMID: 12642047 DOI: 10.1016/s0140-6736(03)12707-9] [Citation(s) in RCA: 163] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND To increase screening and treatment coverage, innovative approaches to cervical-cancer prevention are being investigated in rural Thailand. We assessed the value of a single-visit approach combining visual inspection of the cervix with acetic acid wash (VIA) and cryotherapy. METHODS 12 trained nurses provided services in mobile (village health centre-based) and static (hospital-based) teams in four districts of Roi-et Province, Thailand. Over 7 months, 5999 women were tested by VIA. If they tested positive, after counselling about the benefits, potential risks, and probable side-effects they were offered cryotherapy. Data measuring safety, acceptability, feasibility, and effort to implement the programme were gathered. FINDINGS The VIA test-positive rate was 13.3% (798/5999), and 98.5% (609/618) of those eligible accepted immediate treatment. Overall, 756 women received cryotherapy, 629 (83.2%) of whom returned for their first follow-up visit. No major complications were recorded, and 33 (4.4%) of those treated returned for a perceived problem. Only 17 (2.2%) of the treated women needed clinical management other than reassurance about side-effects. Both VIA and cryotherapy were highly acceptable to the patients (over 95% expressed satisfaction with their experience). At their 1-year visit, the squamocolumnar junction was visible to the nurses, and the VIA test-negative rate was 94.3%. INTERPRETATION A single-visit approach with VIA and cryotherapy seems to be safe, acceptable, and feasible in rural Thailand, and is a potentially efficient method of cervical-cancer prevention in such settings.
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Affiliation(s)
- L Gaffikin
- Cervical Cancer Prevention Programme, JHPIEGO Corporation, 1615 Thames Street, Suite 200, Baltimore, MD 21231, USA.
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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. [PMID: 12509093 DOI: 10.1016/s0889-8545(02)00045-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article has considered recent advances in visual screening methods. Devices that use electro-optical sensors offer great potential in various clinical roles, but considerable additional work is required to develop these devices and it is unlikely that they will come into widespread clinical use in the next 5 years. In contrast numerous studies, demonstrate that simple visual screening methods, such as DVI, have a sensitivity for the detection of women with biopsy-confirmed high-grade SIL (CIN 2,3) and cancer that is equivalent to that of conventional cervical cytology. The primary disadvantage of the simple visual screening methods is poor specificity. These methods classify up to 30% of all women screened as being test positive and as a result new strategies toward managing DVI positive women must be developed before simple visual screening methods can be adopted for routine screening. Enhanced visual methods that use cervicography and speculoscopy may be more specific and improve detection of biopsy-confirmed SIL, but the added time and expense to perform either of these methodologies must be considered and justified. Currently numerous studies are evaluating the best strategies for incorporating visual screening methods into cervical cancer screening programs. In the near future we should be able to determine whether these approaches should be incorporated into routine clinical care.
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Affiliation(s)
- Thomas C Wright
- Department of Pathology, Columbia University, 630 West 168th Street, New York, NY 10032, USA.
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Sankaranarayanan R. Royal Society of Tropical Medicine and Hygiene meeting at Manson House, London 17 January 2002. Cervical cancer in developing countries. Trans R Soc Trop Med Hyg 2002; 96:580-5. [PMID: 12625127 DOI: 10.1016/s0035-9203(02)90317-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The public health importance of cervical cancer is now increasingly appreciated as a means to improve the general health of women in many developing countries. Developing countries account for 80% of the world burden, mostly due to the lack of effective control programmes. Infection with oncogenic types of human papillomaviruses (HPV) has been established as the central cause for cervical cancer. Thus, vaccination against HPV is a potentially useful strategy for prevention, but this may take several years to become a reality. Currently, early detection and treatment is the most effective approach to control cervical cancer. Cervical cancer may be controlled through improving awareness and accessibility to diagnostic and treatment services. Cytology-based screening is beyond the capacity of health services in many developing countries, hence, alternative methods to cytology are being investigated. Visual inspection of the cervix after application of 3-5% acetic acid (VIA) seems to be a promising screening test, with a similar sensitivity to that of cytology, but lower specificity. Currently, it is being evaluated for its cost-effectiveness in reducing cervical cancer incidence and mortality in randomized trials. Information from the ongoing studies will be valuable for evolving cervical cancer control policies and programmes in low-resource settings.
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Affiliation(s)
- R Sankaranarayanan
- International Agency for Research on Cancer, 150 Cours Albert Thomas, F69372, Lyon, France.
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Denny L, Kuhn L, Pollack A, Wright TC. Direct visual inspection for cervical cancer screening: an analysis of factors influencing test performance. Cancer 2002; 94:1699-707. [PMID: 11920531 DOI: 10.1002/cncr.10381] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The 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. METHODS Four tests were used to screen 2754 previously unscreened women: DVI with and without x4.5 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. RESULTS Histologically 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. CONCLUSIONS This 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.
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Affiliation(s)
- Lynette Denny
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Belinson J, Qiao YL, Pretorius R, Zhang WH, Elson P, Li L, Pan QJ, Fischer C, Lorincz A, Zahniser D. Shanxi Province Cervical Cancer Screening Study: a cross-sectional comparative trial of multiple techniques to detect cervical neoplasia. Gynecol Oncol 2001; 83:439-44. [PMID: 11606114 DOI: 10.1006/gyno.2001.6370] [Citation(s) in RCA: 260] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to design a cervical cancer screening algorithm for the developing world that is highly sensitive for cervical intraepithelial neoplasia (CIN) II, III, and cancer and highly specific for CIN II and III, making it possible to ablate the transformation zone without histologic confirmation. METHODS In rural Shanxi Province, China, we examined 1997 women ages 35-45. Each subject underwent a self-test for intermediate and high-risk HPV (by HC-II assay), fluorescence spectroscopy, a liquid-based Pap (read manually and by computer and used as a direct test for HPV), a visual inspection (VIA) diagnosis, and colposcopy with multiple cervical biopsies. RESULTS Mean age was 39.1 +/- 3.16 years, mean number of births was 2.6 +/- 0.93. Based on tests administered, 4.3% subjects had > or =CIN II. All subjects with > or =CIN II had either a ThinPrep Pap (> or =ASCUS) or a positive HPV direct test. The sensitivity and specificity for the detection of > or =CIN II were, respectively, 83 and 86% for the HPV self-test, 95 and 85% for the HPV direct test, 94 and 78% for the ThinPrep Pap (> or =ASCUS), 77 and 98% for the ThinPrep Pap (> or =HGSIL), 94 and 9% for fluorescence spectroscopy, 71 and 74% for VIA, and 81 and 77% for colposcopy. CONCLUSION Based on these data and the existing healthcare infrastructure in China, we believe that further refinement of primary HPV screening using centralized labs is indicated. Self-testing in the local villages may be effective with improvements in the devices and techniques.
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Affiliation(s)
- J Belinson
- Department of Gynecology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Cervical Cancer Screening in Porto Alegre, Brazil. J Low Genit Tract Dis 2001. [DOI: 10.1097/00128360-200101000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Suba EJ, Hung NC, Duc NB, Raab SS. De novo establishment and cost-effectiveness of Papanicolaou cytology screening services in the Socialist Republic of Vietnam. Cancer 2001. [DOI: 10.1002/1097-0142(20010301)91:5<928::aid-cncr1082>3.0.co;2-s] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Naud P, Matos J, Hammes L, Prolla J, Schwartsmann G, Vetorazzi J, Quadros C, Gomes T, Lemos A, Manfrói AD, Marc C, Berti C, Born C, Vettori D, Santos D, Dias E, Cislaghi G, Costa M, Santos R, Marroni R, Magno V, Syrjänen K. Cervical Cancer Screening in Porto Alegre, Brazil: Alternative Methods for Detecting Cancer Precursors in a Developing Country. J Low Genit Tract Dis 2001; 5:24-8. [PMID: 17043558 DOI: 10.1046/j.1526-0976.2001.51005.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study was conducted to test the performance characteristics of cervical cancer screening by visual inspection of the cervix with acetic acid and iodine solution. METHODS A total of 100 women were screened for cervical cancer by Pap smear and naked eye inspection of the cervix after application of acetic acid and iodine solution. RESULTS Comparing visual inspection to the Pap test, a sensitivity of 85.7%, specificity of 78.5%, and concordance of 79% (p < .0011) was established. Comparing the Pap test with colposcopy, the corresponding figures were 42.9%, 92.3%, and 66.6% (p < .077), respectively. Visual inspection compared to colposcopy showed corresponding figures of 100%, 7.7%, and 55.5% (p = .48), respectively. Colposcopy and biopsy had an agreement of 100%. CONCLUSIONS Visual inspection with acetic acid and iodine solution proved to be a reasonable method of screening for cervical cancer precursors.
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Affiliation(s)
- P Naud
- Department of Gynecology and Obstetrics, Federal University of Rio Grande do Sul, Brazil
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Blumenthal PD, Gaffikin L, Chirenje ZM, McGrath J, Womack S, Shah K. Adjunctive testing for cervical cancer in low resource settings with visual inspection, HPV, and the Pap smear. Int J Gynaecol Obstet 2001; 72:47-53. [PMID: 11146077 DOI: 10.1016/s0020-7292(00)00329-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test whether the performance of visual inspection using acetic acid (VIA) could be improved through adjunctive testing and to determine whether the combination of visual inspection of the cervix and HPV testing could prove useful for identifying those at highest risk of cervical precancer. METHODS Between October 1995 and August 1997, 2199 women willing to be screened for cervical cancer in peri-urban clinics in Harare, Zimbabwe received VIA, Pap smear and HPV as screening tests. The presence or absence of (pre)cancer was confirmed via colposcopy with biopsy as indicated for >97% of all women. Computerized simulations of sequential testing scenarios provided estimates of the joint (net) test qualities of different paired combinations of the three tests and allowed for comparisons with the individual test qualities. RESULTS Using HGSIL/CIN II-III as the reference threshold of disease, the net sensitivity and specificity of VIA and HPV when used sequentially were 63.6 and 81.9%, respectively, compared to 43.3 and 91%, respectively, when Pap smears were followed by HPV testing. VIA followed by the Pap smear yielded a net sensitivity of 37.5% and net specificity of 94.3%. CONCLUSIONS For programs with limited resources but with the capacity for HPV testing, sequential testing involving the use of VIA followed by HPV could yield fewer false positives than the use of VIA alone at a cost of relatively few additional false negatives.
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Affiliation(s)
- P D Blumenthal
- Department of Obstetrics and Gynecology, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
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Denny L, Kuhn L, Pollack A, Wainwright H, Wright TC. Evaluation of alternative methods of cervical cancer screening for resource-poor settings. Cancer 2000; 89:826-33. [PMID: 10951346 DOI: 10.1002/1097-0142(20000815)89:4<826::aid-cncr15>3.0.co;2-5] [Citation(s) in RCA: 162] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Noncytologic methods of screening for cervical carcinoma and its precursor lesions are needed for resource-poor settings in which cervical carcinoma continues to be an important cause of morbidity and mortality. METHODS Two thousand nine hundred forty-four women ages 35-65 years were recruited from Cape Town, South Africa and screened using a combination of a Papanicolaou (Pap) smear, human papillomavirus (HPV) DNA testing, direct visual inspection after the application of a 5% acetic acid solution (DVI), and cervicography. Cervicography was considered primarily as a method with which to quality control the DVI examinations. Women with squamous intraepithelial lesions (SIL) or carcinoma on Pap smear, positive DVI examination (acetowhite lesion or cervical ulcer/growth), high levels of high risk HPV DNA (relative light units [RLU] > 10x positive control), or positive Cervigramtrade mark were referred for colposcopy and cervical biopsy. RESULTS Pap smears were positive in 8.1% of all women screened and identified 65 (78%) of all cases of biopsy confirmed high grade disease (high grade SIL or invasive carcinoma). DVI and cervicography were classified as positive in 18.1% and 10.5%, respectively, of women screened and identified 58 (67%) and 46 (58%) of all cases of high grade disease, respectively. The results of HPV DNA testing varied depending on the cutoff value used to define a positive result. At the standard cutoff level (RLU > 1x positive control), 16.2% of women screened were classified as high risk HPV DNA positive, as were 63 women with high grade disease (73%). CONCLUSIONS DVI and HPV DNA testing identified similar numbers of high grade SIL (cervical intraepithelial neoplasia Grade 2,3) and invasive carcinoma cases as Pap smears. However, both classify considerably more women without cervical disease as being test positive.
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Affiliation(s)
- L Denny
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
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Denny L, Kuhn L, Risi L, Richart RM, Pollack A, Lorincz A, Kostecki F, Wright TC. Two-stage cervical cancer screening: an alternative for resource-poor settings. Am J Obstet Gynecol 2000; 183:383-8. [PMID: 10942474 DOI: 10.1067/mob.2000.105871] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to introduce 2-stage cervical cancer screening in which 2 screening tests are performed sequentially (the second test is performed only if the first result is positive), followed by treatment if both test results are abnormal. STUDY DESIGN A total of 1423 women from Cape Town, South Africa, were screened by direct visual inspection, human papillomavirus deoxyribonucleic acid testing, cytologic testing, and cervicography. If an abnormality was identified with any test, women were referred for colposcopy. RESULTS Direct visual inspection, cytologic testing, human papillomavirus deoxyribonucleic acid testing, and cervicography, when used alone, identified 24, 26, 23, and 23 cases of disease (high-grade squamous intraepithelial lesion or cancer) per 1000 women, respectively, and would classify 182, 71, 137, and 112 women without disease as having abnormal results. Two-stage screening with direct visual inspection first, followed by cytologic testing, human papillomavirus deoxyribonucleic acid testing, or cervicography, would detect 18, 16, and 18 cases per 1000 women, respectively, and would substantially reduce the number of women without disease who were classified as having abnormal results. CONCLUSION Two-stage screening for cervical cancer provides an attractive alternative to conventional screening for low-resource settings.
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Affiliation(s)
- L Denny
- Department of Obstetrics and Gynecology, University of Cape Town, South Africa
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Womack SD, Chirenje ZM, Blumenthal PD, Gaffikin L, McGrath JA, Chipato T, Ngwalle E, Shah KV. Evaluation of a human papillomavirus assay in cervical screening in Zimbabwe. BJOG 2000; 107:33-8. [PMID: 10645859 DOI: 10.1111/j.1471-0528.2000.tb11576.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the utility of an assay for high risk genital human papillomavirus (HPV) in cervical screening in Zimbabwe, Africa. DESIGN Cross-sectional study. SETTING Harare, Zimbabwe. POPULATION Zimbabwe women (n = 2,140), 25 to 55 years old, recruited in clinics in Chitungwiza and Greater Harare. METHODS Genital specimens were assessed for HPV, using the HPV DNA test Hybrid Capture II (probe B). Further assessment of the women was conducted using colposcopy and biopsy as indicated. High grade squamous intraepithelial lesions were diagnosed in 215 women. Colposcopy and/or biopsy showed low grade lesions in 346 women. RESULTS The overall prevalences were: 42 x 7% for HPV, 10% for high grade squamous intraepithelial lesions and 16% for low grade lesions. Prevalence for HPV decreased significantly with increase in age (P for trend < 0 x 0001) and increased significantly with increasing disease severity, from 35% in normal women, to 53% in women with low grade lesions and 81% in women with high grade lesions (P for trend < 0 x 001). In specimens positive for HPV, the amount was 14-fold higher in women with high grade lesions compared with normal women. In screening for high grade lesions the assay for HPV had a sensitivity of 81% (CI 75%-86%); sensitivity for low grade lesions was 64% (CI 60%-68%). Specificity was 62% (CI 59%-64%) for high grade lesions and 65% (CI 62%-67%) for low grade lesions. The positive predictive value was 19% (CI 17%-22%) for high grade lesions and 39% (CI 36%-42%) for low grade lesions. CONCLUSION For high grade squamous intraepithelial lesions the sensitivity of the Hybrid Capture II HPV DNA test was high, but the specificity was relatively low. The test may therefore be most useful in conjunction with other screening tests.
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Affiliation(s)
- S D Womack
- Department of Molecular Microbiology and Immunology, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland 21205-2179, USA
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Mitchell MF, Cantor SB, Brookner C, Utzinger U, Schottenfeld D, Richards-Kortum R. SCREENING FOR SQUAMOUS INTRAEPITHELIAL LESIONS WITH FLUORESCENCE SPECTROSCOPY. Obstet Gynecol 1999. [DOI: 10.1097/00006250-199911001-00046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cullins VE, Wright TC, Beattie KJ, Pollack AE. Cervical cancer prevention using visual screening methods. REPRODUCTIVE HEALTH MATTERS 1999. [DOI: 10.1016/s0968-8080(99)90014-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Visual inspection with acetic acid for cervical-cancer screening: test qualities in a primary-care setting. University of Zimbabwe/JHPIEGO Cervical Cancer Project. Lancet 1999. [PMID: 10093978 DOI: 10.1016/s0140-6736(98)07033-0] [Citation(s) in RCA: 213] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Naked-eye visual inspection of the cervix with acetic-acid wash (VIA), or cervicoscopy, is an alternative to cytology in screening for cervical cancer in poorly resourced locations. We tested the sensitivity, specificity, and predictive value of VIA done by nurse-midwives in a less-developed country. METHODS Women were screened by six trained nurse-midwives in a two-phase, cross-sectional study at 15 primary-care clinics in Zimbabwe. VIA and Pap smears were done concurrently, and their sensitivity and specificity compared. Colposcopy, with biopsy as indicated, was used as the reference test to allow a direct comparison of the test unaffected by verification bias. FINDINGS 10934 women were screened. In phase II, 2148 (97.5%) of the 2203 participants for whom there was a screening result also had a reference test result. Also in phase II, VIA was more sensitive but less specific than cytology. Sensitivity (95% CI) was 76.7% (70.3-82.3) for VIA and 44.3% (37.3-51.4) for cytology. Specificity was 64.1% (61.9-66.2) for VIA and 90.6% (89.2-91.9) for cytology. INTERPRETATION The high sensitivity of VIA shows that the test could be valuable in detection of precancerous lesions of the cervix. However, there are costs to the patient and system costs associated with high numbers of false-positive results, so attention should be given to improving the specificity of VIA.
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Abstract
Presenting this lecture named for my colleague, the late Robert Tiffany, is an honor. He was part of the first International Conference on Cancer Nursing 20 years ago, which was my first international meeting. It was part of what expanded our Texas--only cancer prevention and detection program for nurses into an international effort. Lessons acquired through this work in the past include learning to respect and honor cultural differences, adapting control programs to the resources at hand, accepting a role as a leader and being an agent for change, and passing on what has been learned to others. The challenges of today include the worldwide death and disability toll of lung cancer, the threat of breast cancer and the promise of regular screening to lower its morbidity and mortality, and the hope that a willingness to adapt screening for cervical cancer in developing countries will lower its mortality rate. Twenty years in the future we can expect nurses to remain educators, exemplars, and agents of change; cancer prevention and early detection to rise in the hierarchy of care; continued collaborative care between physicians and nurses; enhanced patient care through information access; and a larger role for cancer genetics in nursing practice.
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Affiliation(s)
- L W Hilton
- Department of Clinical Cancer Prevention, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA
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Sankaranarayanan R, Shyamalakumary B, Wesley R, Sreedevi Amma N, Parkin DM, Nair MK. Visual inspection with acetic acid in the early detection of cervical cancer and precursors. Int J Cancer 1999; 80:161-3. [PMID: 9935247 DOI: 10.1002/(sici)1097-0215(19990105)80:1<161::aid-ijc28>3.0.co;2-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Sankaranarayanan R, Wesley R, Somanathan T, Dhakad N, Shyamalakumary B, Amma NS, Parkin DM, Nair MK. Visual inspection of the uterine cervix after the application of acetic acid in the detection of cervical carcinoma and its precursors. Cancer 1998. [DOI: 10.1002/(sici)1097-0142(19981115)83:10<2150::aid-cncr13>3.0.co;2-0] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Guelrud M, Herrera I. Acetic acid improves identification of remnant islands of Barrett's epithelium after endoscopic therapy. Gastrointest Endosc 1998; 47:512-5. [PMID: 9647377 DOI: 10.1016/s0016-5107(98)70253-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Instillation of acetic acid onto the uterine cervix at colposcopy has been used for many years to highlight dysplastic areas and thereby enhance the ability to obtain targeted biopsy specimens. As part of an ongoing trial of multipolar electrocoagulation for Barrett's esophagus, we sought to develop a simple technique to identify small islands of residual specialized columnar epithelium after treatment. METHODS In 21 consecutive patients, 5 to 10 mL of 1.5% acetic acid was sprayed onto the distal esophagus using a spray catheter, followed immediately by spraying 50 mL of tap water. RESULTS Initially, a whitish coloration developed in both esophageal and gastric epithelia. After 2 to 3 minutes, the esophageal squamous mucosa remained white but the columnar epithelium became reddish. Remnant islands of Barrett's epithelium were outlined by a white rim. CONCLUSION Acetic acid instillation enhances the ability to detect small or indistinguishable remnant islands of columnar epithelium after endoscopic treatment of Barrett's esophagus. This method is safe, rapid, and inexpensive.
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Affiliation(s)
- M Guelrud
- Policlinica Metropolitana, Urb. Caurimare, Caracas, Venezuela
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