Evaluation of alternative methods of cervical cancer screening for resource‐poor settings

• Published in: Cancer Vol. 89; no. 4; pp. 826 - 833
• Main Authors: Denny, Lynette, Kuhn, Louise, Pollack, Amy, Wainwright, Helen, Wright, Thomas C.
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 15.08.2000; Wiley-Liss
• Subjects: Adult; Aged; Biological and medical sciences; cervical intraepithelial neoplasia (CIN); Cervical Intraepithelial Neoplasia - epidemiology; Cervical Intraepithelial Neoplasia - etiology; cervicography; Cervix; Colposcopy; Demography; Diagnostic Techniques and Procedures; direct visual inspection (DVI); DNA, Viral - analysis; Evaluation Studies as Topic; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; human papillomavirus; Humans; Mass Screening - methods; Medical sciences; Middle Aged; Neoplasm Invasiveness - prevention & control; Papanicolaou (Pap) smears; Papanicolaou Test; Papillomaviridae - genetics; Papillomaviridae - isolation & purification; Prevalence; squamous intraepithelial lesions (SIL); Tropical medicine; Tumors; Uterine Cervical Diseases - epidemiology; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - prevention & control; Vaginal Smears; South Africa(Republic); Africa; Carcinoma; Cervical smear; Papovaviridae; Uterine cervix; Papillomavirus; Human papillomavirus; Papanicolaou smear test; Public health; Human; Dysplasia; Premalignant lesion; Visual observation; Malignant tumor; Method; Medical screening; Female genital diseases; Virus; Photography; Pathology; DNA; Cytopathology; Acetic acid; Uterine cervix diseases; Comparative study; High malignancy
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(20000815)89:4<826::AID-CNCR15>3.0.CO;2-5

BACKGROUND Noncytologic methods of screening for cervical carcinoma and its precursor lesions are needed for resource‐poor settings in which cervical carcinoma continues to be an important cause of morbidity and mortality. METHODS Two thousand nine hundred forty‐four women ages 35–65 years were recruited from Cape Town, South Africa and screened using a combination of a Papanicolaou (Pap) smear, human papillomavirus (HPV) DNA testing, direct visual inspection after the application of a 5% acetic acid solution (DVI), and cervicography. Cervicography was considered primarily as a method with which to quality control the DVI examinations. Women with squamous intraepithelial lesions (SIL) or carcinoma on Pap smear, positive DVI examination (acetowhite lesion or cervical ulcer/growth), high levels of high risk HPV DNA (relative light units [RLU] > 10× positive control), or positive Cervigram™ were referred for colposcopy and cervical biopsy. RESULTS Pap smears were positive in 8.1% of all women screened and identified 65 (78%) of all cases of biopsy confirmed high grade disease (high grade SIL or invasive carcinoma). DVI and cervicography were classified as positive in 18.1% and 10.5%, respectively, of women screened and identified 58 (67%) and 46 (58%) of all cases of high grade disease, respectively. The results of HPV DNA testing varied depending on the cutoff value used to define a positive result. At the standard cutoff level (RLU > 1× positive control), 16.2% of women screened were classified as high risk HPV DNA positive, as were 63 women with high grade disease (73%). CONCLUSIONS DVI and HPV DNA testing identified similar numbers of high grade SIL (cervical intraepithelial neoplasia Grade 2,3) and invasive carcinoma cases as Pap smears. However, both classify considerably more women without cervical disease as being test positive. Cancer 2000;89:826–33. © 2000 American Cancer Society. Direct visual inspection and human papillomavirus DNA testing identify similar numbers of cases of high grade squamous intraepithelial lesions (cervical intraepithelial neoplasia Grade 2,3) and invasive cervical carcinoma as does Papanicolaou smear screening. However, both methods classify considerably more women without cervical disease as being test positive.