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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India
International Journal of Cancer, Volume 123, No. 1, Year 2008
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Description
Cervical cancer is the main cancer among women in sub-Saharan Africa, India and other parts of the developing world. Evaluation of screening performance of effective, feasible and affordable early detection and management methods is a public health priority. Five screening methods, naked eye visual inspection of the cervix uteri after application of diluted acetic acid (VIA), or Lugol's iodine (VILI) or with a magnifying device (VIAM), the Pap smear and human papillomavirus testing with the high-risk probe of the Hybrid Capture-2 assay (HC2), were evaluated in 11 studies in India and Africa. More than 58,000 women, aged 25-64 years, were tested with 2-5 screening tests and outcome verification was done on all women independent of the screen test results. The outcome was presence or absence of cervical intraepithelial neoplasia (CIN) of different degrees or invasive cervical cancer. Verification was based on colposcopy and histological interpretation of colposcopy-directed biopsies. Negative colposcopy was accepted as a truly negative outcome. VIA showed a sensitivity of 79% (95% CI 73-85%) and 83% (95% CI 77-89%), and a specificity of 85% (95% CI 81-89%) and 84% (95% CI 80-88%) for the outcomes CIN2+ or CIN3+, respectively. VILI was on average 10% more sensitive and equally specific. VIAM showed similar results as VIA. The Pap smear showed lowest sensitivity, even at the lowest cutoff of atypical squamous cells of undetermined significance (57%; 95% CI 38-76%) for CIN2+ but the specificity was rather high (93%; 95% CI 89-97%). The HC2-assay showed a sensitivity for CIN2+ of 62% (95% CI 56-68%) and a specificity of 94% (95% CI 92-95%). Substantial interstudy variation was observed in the accuracy of the visual screening methods. Accuracy of visual methods and cytology increased over time, whereas performance of HC2 was constant. Results of visual tests and colposcopy were highly correlated. This study was the largest ever done that evaluates the cross-sectional accuracy of screening tests for cervical cancer precursors in developing countries. The merit of the study was that all screened subjects were submitted to confirmatory investigations avoiding to verification bias. A major finding was the consistently higher sensitivity but equal specificity of VILI compared with VIA. Nevertheless, some caution is warranted in the interpretation of observed accuracy measures, since a certain degree of gold standard misclassiflcation cannot be excluded. Because of the correlation between visual screening tests and colposcopy and a certain degree of over-diagnosis of apparent CIN2+ by study pathologists, it is possible that both sensitivity and specificity of VIA and VILI were overestimated. Gold standard verification error could also explain the surprisingly low sensitivity of HC2, which contrasts with findings from other studies. © 2008 Wiley-Liss, Inc.
Authors & Co-Authors
Arbyn, Marc
Belgium, Brussels
Scientific Institute of Public Health, Brussels
Sankaranarayanan, Rengaswamy
France, Lyon
Centre International de Recherche Sur le Cancer
Muwonge, Richard
France, Lyon
Centre International de Recherche Sur le Cancer
Keïta, Namory
Guinea, Conakry
Université de Conakry
Dolo, Amardou
Mali, Bamako
Hopital Gabriel Toure
Mbalawa, Charles Gombé
Congo, Brazzaville
Universite Marien Ngouabi
Nouhou, Hassan
Niger, Niamey
Universite Abdou Moumouni
Sakande, Boblewende
Burkina Faso
Clinique Philadelphie
Wesley, Ramani S.
India, Thiruvananthapuram
Regional Cancer Centre India
Somanathan, Thara
India, Thiruvananthapuram
Regional Cancer Centre India
Sharma, Anjali
India, Jaipur
Bhagwan Mahaveer Cancer Hospital and Research Centre
Shastri, Surendra
India, Mumbai
Tata Memorial Hospital
Basu, Partha Sarathi
India, Kolkata
Chittaranjan National Cancer Institute
Statistics
Citations: 308
Authors: 13
Affiliations: 11
Identifiers
Doi:
10.1002/ijc.23489
ISSN:
00207136
e-ISSN:
10970215
Research Areas
Cancer
Health System And Policy
Study Design
Cross Sectional Study
Participants Gender
Female