Visual inspection as a cervical cancer screening method in a primary health care setting in Africa

Ghislain Sangwa-Lugoma, Salaheddin Mahmud, Samih H. Nasr, Jean Liaras, Patrick K. Kayembe, Rahma R. Tozin, Pierre Drouin, Attila Lorincz, Alex Ferenczy, Eduardo L. Franco

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1389-1395
Number of pages7
JournalInternational Journal of Cancer
Volume119
Issue number6
DOIs
StatePublished - Sep 15 2006
Externally publishedYes

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Early Detection of Cancer
Uterine Cervical Neoplasms
Acetic Acid
Primary Health Care
Nurses
Cell Biology
Colposcopy
Cervical Intraepithelial Neoplasia
Physicians
Democratic Republic of the Congo
Biopsy
Lugol's solution
Costs and Cost Analysis
Sensitivity and Specificity

Keywords

  • Cervical cancer
  • Cervical intraepithelial neoplasia
  • Pap cytology
  • Screening
  • Visual inspection

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Sangwa-Lugoma, G., Mahmud, S., Nasr, S. H., Liaras, J., Kayembe, P. K., Tozin, R. R., ... Franco, E. L. (2006). Visual inspection as a cervical cancer screening method in a primary health care setting in Africa. International Journal of Cancer, 119(6), 1389-1395. https://doi.org/10.1002/ijc.21972

Visual inspection as a cervical cancer screening method in a primary health care setting in Africa. / Sangwa-Lugoma, Ghislain; Mahmud, Salaheddin; Nasr, Samih H.; Liaras, Jean; Kayembe, Patrick K.; Tozin, Rahma R.; Drouin, Pierre; Lorincz, Attila; Ferenczy, Alex; Franco, Eduardo L.

In: International Journal of Cancer, Vol. 119, No. 6, 15.09.2006, p. 1389-1395.

Research output: Contribution to journalArticle

Sangwa-Lugoma, G, Mahmud, S, Nasr, SH, Liaras, J, Kayembe, PK, Tozin, RR, Drouin, P, Lorincz, A, Ferenczy, A & Franco, EL 2006, 'Visual inspection as a cervical cancer screening method in a primary health care setting in Africa', International Journal of Cancer, vol. 119, no. 6, pp. 1389-1395. https://doi.org/10.1002/ijc.21972
Sangwa-Lugoma G, Mahmud S, Nasr SH, Liaras J, Kayembe PK, Tozin RR et al. Visual inspection as a cervical cancer screening method in a primary health care setting in Africa. International Journal of Cancer. 2006 Sep 15;119(6):1389-1395. https://doi.org/10.1002/ijc.21972
Sangwa-Lugoma, Ghislain ; Mahmud, Salaheddin ; Nasr, Samih H. ; Liaras, Jean ; Kayembe, Patrick K. ; Tozin, Rahma R. ; Drouin, Pierre ; Lorincz, Attila ; Ferenczy, Alex ; Franco, Eduardo L. / Visual inspection as a cervical cancer screening method in a primary health care setting in Africa. In: International Journal of Cancer. 2006 ; Vol. 119, No. 6. pp. 1389-1395.
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N2 - 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.

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