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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Visual inspection as a cervical cancer screening method in a primary health care setting in Africa
International Journal of Cancer, Volume 119, No. 6, Year 2006
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Description
We evaluated the feasibility and performance of visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) for cervical cancer screening in a primary health-care setting in Kinshasa, Congo. Women (1,528) aged ≥30 years were screened independently by nurses and physicians by VIA and VILI and Pap cytology. Biopsy samples were obtained from women with abnormal colposcopies and from 290 randomly chosen women with normal colposcopy. Cytological and histological examinations were performed in Lyon and Montreal, respectively. The prevalence of cervical intraepithelial neoplasia (CIN) of grades 1, 2 and 3 was 4.5, 1.3 and 4%, respectively. Using biopsy as the reference, the sensitivity, specificity and negative predictive value (NPV) for ≥CIN 2 for VIA-nurse were 55.5% (95% CI:34.7-76.2), 64.6% (95% CI: 62.0-67.1) and 96.8% (95% CI: 93.5-98.7), respectively. The corresponding values for VILI-nurse were 44.0% (95% CI: 24.2-63.8), 74.6% (95% CI: 72.3-76.9) and 96.7% (95% CI: 93.7-98.6). The equivalent parameters for physicians were 71.1% (95% CI: 46.7-95.5), 71.3% (95% CI: 68.9-73.6) and 98.6% (95% CI: 96.0-99.7) for VIA and 68.3% (95% CI: 42.5-94.0), 76.2% (95% CI: 74.0-78.4) and 97.2% (95% CI: 95.3-98.5) for VILI. The sensitivity of cytology ranged between 31 and 72%, depending on the abnormality threshold used to define positivity, with a corresponding specificity range of 94-99% and a NPV range of 97-99%. Our results show that VIA and VILI performed by nurses and physicians are slightly more sensitive but less specific than Pap cytology across multiple combinations of test and lesion thresholds. Given their lower cost and easy deployment, visual inspection methods merit further assessment as cervical cancer screening methods for low-resource countries. © 2006 Wiley-Liss, Inc.
Authors & Co-Authors
Sangwa-Lugoma, Ghislain
Democratic Republic Congo, Kinshasa
Universite de Kinshasa
Canada, Edmonton
University of Alberta
Canada, Montreal
Université Mcgill
Mahmud, Salaheddin Murad
Canada, Montreal
Université Mcgill
Nasr, Samih H.
Canada, Montreal
Université Mcgill
Liaras, Jean
France, Lyon
Groupement de Recherche Cytologique
Kayembé, Patrick Kalambayi
Congo
Ecole de Santé Publique de Kinshasa
Tozin, Rahma Rashid
Democratic Republic Congo, Kinshasa
Universite de Kinshasa
Drouin, Pierre
Canada, Montreal
Centre Hospitalier de L'universite de Montreal
Lörincz, Attila Tibor
United States, Gaithersburg
Digene Corporation
Ferenczy, Alex S.
Canada, Montreal
Université Mcgill
Canada, Montreal
Sir Mortimer B. Davis Jewish General Hospital
Franco, Eduardo Luis Fabiano
Canada, Montreal
Université Mcgill
Statistics
Citations: 119
Authors: 10
Affiliations: 8
Identifiers
Doi:
10.1002/ijc.21972
ISSN:
00207136
e-ISSN:
10970215
Research Areas
Cancer
Health System And Policy
Study Design
Cross Sectional Study
Study Locations
Congo
Participants Gender
Female