Adjunctive testing for cervical cancer in low resource settings with visual inspection, HPV, and the Pap smear
- 2 January 2001
- journal article
- research article
- Published by Wiley in International Journal of Gynecology & Obstetrics
- Vol. 72 (1) , 47-53
- https://doi.org/10.1016/s0020-7292(00)00329-5
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.Keywords
This publication has 16 references indexed in Scilit:
- Evaluation of a human papillomavirus assay in cervical screening in Zimbabwe.BJOG: An International Journal of Obstetrics and Gynaecology, 2000
- Visual inspection with acetic acid for cervical-cancer screening: test qualities in a primary-care settingThe Lancet, 1999
- Visual inspection with acetic acid in the early detection of cervical cancer and precursorsInternational Journal of Cancer, 1999
- Visual inspection of the uterine cervix after the application of acetic acid in the detection of cervical carcinoma and its precursorsCancer, 1998
- A Review of Cervical Cancer Screening Intervention Research: Implications for Public Health Programs and Future ResearchPreventive Medicine, 1998
- Acetic acid visualization of the cervix: an alternative to cytologic screeningObstetrics & Gynecology, 1996
- The effect of mass screening on incidence and mortality of squamous and adenocarcinoma of cervix uteriObstetrics & Gynecology, 1995
- An evaluation of human papillomavirus testing for intermediate- and high-risk types as triage before colposcopyAmerican Journal of Obstetrics and Gynecology, 1995
- Human papillomavirus testing by hybrid capture appears to be useful in triaging women with a cytologic diagnosis of atypical squamous cells of undetermined significanceAmerican Journal of Obstetrics and Gynecology, 1995
- Comparison between Methods for Human Papillomavirus DNA Testing: A Model for Self-Testing in Young WomenThe Journal of Infectious Diseases, 1993