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Cervical Visual Inspection with Acetic Acid (VIA) and Oncogenic Human Papillomavirus Screening in Rural Indigenous Guatemalan Women: Time to Rethink VIA

Authors :
Eric Fenkl
Michael Dean
Ariel Bernardo Marroquin-Garcia
Diego Aurelio Cordova-Toma
Anne Jeffries
Virginia McCoy
Consuelo M. Beck-Sague
Purnima Madhivanan
Source :
International Journal of Environmental Research and Public Health, Vol 18, Iss 12406, p 12406 (2021), International Journal of Environmental Research and Public Health, International Journal of Environmental Research and Public Health; Volume 18; Issue 23; Pages: 12406
Publication Year :
2021
Publisher :
MDPI AG, 2021.

Abstract

Single-visit “screen-and-treat” strategies using visual inspection with acetic acid (VIA) and cryotherapy (liquid nitrous oxide ablation) in low-resource settings are commonly used to detect and treat precancerous lesions for cervical cancer prevention. This study compared VIA sensitivity and specificity in rural indigenous Guatemalan communities, to that of oncogenic human papillomavirus (HPV) testing for detection of precancerous changes, using cytology as the reference standard. Between 3–8 September 2017, trained nurses examined 222 women aged 23–58 years with VIA. Specimens for liquid-based cytology and HPV testing were obtained prior to VIA with a cytobrush and transported in PreservCyt to a US clinical laboratory. VIA and HPV test sensitivities were assessed as proportions of women with abnormal cytology that had abnormal VIA or HPV results, respectively, and specificities, as proportions with normal cytology with normal VIA or negative HPV tests. Of 222 women, 18 (8.1%) had abnormal cytology (1 carcinoma in a participant who received VIA-based cryotherapy in 2015, 4 high- and 5 low-grade squamous intraepithelial lesions, and 8 atypical squamous cells of undetermined significance (ASCUS)). Excluding ASCUS, sensitivities of VIA and HPV were 20.0% and 100%, respectively. VIA-based screening may not be acceptable for detecting precancerous lesions, and field cryotherapy for preventing malignancy. The World Health Organization recommended in 2021 “…using HPV DNA detection as the primary screening test rather than VIA or cytology”.

Details

Language :
English
ISSN :
16617827 and 16604601
Volume :
18
Issue :
12406
Database :
OpenAIRE
Journal :
International Journal of Environmental Research and Public Health
Accession number :
edsair.doi.dedup.....256e469de551a757d582c388d8c2370f