A Population-based Study of Visual Inspection with Acetic Acid (VIA) for Cervical Screening in Rural Nigeria

Overview

Journal Int J Gynecol Cancer

Specialties Gynecology & Obstetrics
Oncology

Date 2013 Jan 29

PMID 23354369

Citations 32

Authors

Kayode Olusegun Ajenifuja

Julia C Gage

Akinfolarin C Adepiti

Nicolas Wentzensen

Claire Eklund

Mary Reilly

Martha Hutchinson

Robert D Burk

Mark Schiffman

Affiliations

Soon will be listed here.

Abstract

Objective: Cervical cancer is the most common gynecological cancer in developing countries. Visual inspection with acetic acid (VIA) was introduced to screen for cervical premalignant lesions in developing countries owing to the inability of many countries to implement high-quality cytologic services. We sought to compare VIA performance among different health workers in Nigeria.

Methods: In a population-based project, 7 health workers who had been screening women with VIA for approximately 2 years at local government health centers in rural Nigeria were retrained in a 2-week program using the International Agency for Research on Cancer training manual. Women from a rural village who had never had cervical cancer screening were recruited into the study. Each woman had cervical cancer screening by VIA, liquid-based cytologic test, and oncogenic human papillomavirus (HPV) DNA test.

Results: Despite similar participant characteristics, across all age groups, providers had wide ranges of VIA results; 0% to 21% suspect cancer and 0% to 25% were VIA positive. Visual inspection with acetic acid was insensitive compared to a combination of cytologic and HPV tests.

Conclusion: In our study, VIA was not reproducible, nor was it sensitive compared to cytologic and HPV tests.

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References

Megevand E, Denny L, Dehaeck K, Soeters R, Bloch B . Acetic acid visualization of the cervix: an alternative to cytologic screening. Obstet Gynecol. 1996; 88(3):383-6. DOI: 10.1016/0029-7844(96)00189-5. View

Pisani P, Parkin D, Bray F, Ferlay J . Estimates of the worldwide mortality from 25 cancers in 1990. Int J Cancer. 1999; 83(1):18-29. DOI: 10.1002/(sici)1097-0215(19990924)83:1<18::aid-ijc5>3.0.co;2-m. View

Pretorius R, Bao Y, Belinson J, Burchette R, Smith J, Qiao Y . Inappropriate gold standard bias in cervical cancer screening studies. Int J Cancer. 2007; 121(10):2218-24. DOI: 10.1002/ijc.22991. View

Ferlay J, Shin H, Bray F, Forman D, Mathers C, Parkin D . Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2011; 127(12):2893-917. DOI: 10.1002/ijc.25516. View

Sankaranarayanan R, Ferlay J . Worldwide burden of gynaecological cancer: the size of the problem. Best Pract Res Clin Obstet Gynaecol. 2005; 20(2):207-25. DOI: 10.1016/j.bpobgyn.2005.10.007. View

Lazcano-Ponce E, Moss S, Alonso de Ruiz P, Salmeron Castro J, Avila M . Cervical cancer screening in developing countries: why is it ineffective? The case of Mexico. Arch Med Res. 1999; 30(3):240-50. DOI: 10.1016/s0188-0128(99)00006-8. View

Almonte M, Ferreccio C, Winkler J, Cuzick J, Tsu V, Robles S . Cervical screening by visual inspection, HPV testing, liquid-based and conventional cytology in Amazonian Peru. Int J Cancer. 2007; 121(4):796-802. DOI: 10.1002/ijc.22757. View

Safaeian M, Solomon D, Castle P . Cervical cancer prevention--cervical screening: science in evolution. Obstet Gynecol Clin North Am. 2007; 34(4):739-60, ix. PMC: 2762353. DOI: 10.1016/j.ogc.2007.09.004. View

Sankaranarayanan R, Rajkumar R, Esmy P, Fayette J, Shanthakumary S, Frappart L . Effectiveness, safety and acceptability of 'see and treat' with cryotherapy by nurses in a cervical screening study in India. Br J Cancer. 2007; 96(5):738-43. PMC: 2360066. DOI: 10.1038/sj.bjc.6603633. View

10.

Bhatla N, Mukhopadhyay A, Joshi S, Kumar A, Kriplani A, Pandey R . Visual inspection for cervical cancer screening: evaluation by doctor versus paramedical worker. Indian J Cancer. 2004; 41(1):32-6. View

11.

Chokunonga E, Levy L, Bassett M, Mauchaza B, Thomas D, Parkin D . Cancer incidence in the African population of Harare, Zimbabwe: second results from the cancer registry 1993-1995. Int J Cancer. 1999; 85(1):54-9. DOI: 10.1002/(sici)1097-0215(20000101)85:1<54::aid-ijc10>3.0.co;2-d. View

12.

Belinson J, Qiao Y, Pretorius R, Zhang W, Elson P, Li L . Shanxi Province Cervical Cancer Screening Study: a cross-sectional comparative trial of multiple techniques to detect cervical neoplasia. Gynecol Oncol. 2001; 83(2):439-44. DOI: 10.1006/gyno.2001.6370. View

13.

Gage J, Ajenifuja K, Wentzensen N, Adepiti A, Eklund C, Reilly M . The age-specific prevalence of human papillomavirus and risk of cytologic abnormalities in rural Nigeria: implications for screen-and-treat strategies. Int J Cancer. 2011; 130(9):2111-7. PMC: 3227742. DOI: 10.1002/ijc.26211. View

14.

Onwudiegwu U, Bako A, Oyewumi A . Cervical cancer--a neglected health tragedy. J Obstet Gynaecol. 2004; 19(1):61-4. DOI: 10.1080/01443619966001. View

15.

Cannistra S, Niloff J . Cancer of the uterine cervix. N Engl J Med. 1996; 334(16):1030-8. DOI: 10.1056/NEJM199604183341606. View

16.

Koulibaly M, Kabba I, Cisse A, Diallo S, Diallo M, Keita N . Cancer incidence in Conakry, Guinea: first results from the Cancer Registry 1992-1995. Int J Cancer. 1997; 70(1):39-45. DOI: 10.1002/(sici)1097-0215(19970106)70:1<39::aid-ijc6>3.0.co;2-7. View

17.

Cagle A, Hu S, Sellors J, Bao Y, Lim J, Li S . Use of an expanded gold standard to estimate the accuracy of colposcopy and visual inspection with acetic acid. Int J Cancer. 2009; 126(1):156-61. DOI: 10.1002/ijc.24719. View

18.

Sherigar B, Dalal A, Durdi G, Pujar Y, Dhumale H . Cervical cancer screening by visual inspection with acetic acid--interobserver variability between nurse and physician. Asian Pac J Cancer Prev. 2010; 11(3):619-22. View

19.

Adeniji K . Analysis of the histopathological pattern of carcinoma of the cervix in Ilorin, Nigeria. Niger J Med. 2002; 10(4):165-8. View

20.

Olusegun A, Onwudiegwu U, Ogunniyi S, Loto O, Clement A, Godwin O . Trend in the presentation of cervical cancer in Nigeria. Saudi Med J. 2008; 29(8):1203-4. View