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Acetic-acid guided visual inspection vs. cytology-based screening for cervical cancer in the Philippines
C A Ngelangel1, G M Limson, C P Cordero
1University of the Philippines Department of Health, Cervical Cancer Screening Health Operations Study Group, National Institutes of Health, Pedro Gil, Ermita, Manila, Philippines.
Objectives:
To compare the validity and acceptability of acetic-acid visualization (VIA), magnified acetic-acid visualization (VIAM), spatula+cotton swab-Papanicolaou (Pap) smear (SS), and cervical brush-Pap smear (CB) in the detection of precursor/early cervical cancer lesions.
Methods:
A total of 12992 women aged between 25 and 65 years from 14 Philippine centers were randomly allocated to the four tests. The gold standard was colposcopy with biopsy for positive/suspicious cases.
Results:
Sensitivity rates [95% confidence intervals (CIs)] were 37 (CI, 26.8-48.5), 34.1 (CI, 24.8-44.8), 14.3 (CI, 6.4-27.8), and 19.1 (CI, 9.2-34.6) for VIA, VIAM, SS, and CB, respectively. Specificity rates were 90.7 (CI, 89.6-91.7), 90.7 (CI, 89-91.1), 97.5 (CI, 96.8-98), and 97.9 (CI, 97.3-98.4), respectively. Kappa for the Pap smear (PS) within centers ranged from -0.154 to 0.783, and between centers from -0.028 to 0.364. Screeners preferred CB; screened-women preferred VIA.
Conclusions:
The acetic-acid visualization and VIAM methods are recommended for initial cervical cancer screening in the Philippines.
