Evaluation of alternative methods of cervical cancer screening for resource‐poor settings
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 recr...
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Published in | Cancer Vol. 89; no. 4; pp. 826 - 833 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
New York
John Wiley & Sons, Inc
15.08.2000
Wiley-Liss |
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Abstract | 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. |
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AbstractList | BACKGROUNDNoncytologic 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.METHODSTwo 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] > 10x positive control), or positive Cervigramtrade mark were referred for colposcopy and cervical biopsy.RESULTSPap 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 > 1x positive control), 16.2% of women screened were classified as high risk HPV DNA positive, as were 63 women with high grade disease (73%).CONCLUSIONSDVI 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. 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. 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. 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] > 10x positive control), or positive Cervigramtrade mark were referred for colposcopy and cervical biopsy. 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 > 1x positive control), 16.2% of women screened were classified as high risk HPV DNA positive, as were 63 women with high grade disease (73%). 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. |
Author | Denny, Lynette Kuhn, Louise Wright, Thomas C. Wainwright, Helen Pollack, Amy |
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Keywords | 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 |
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Noncytologic methods of screening for cervical carcinoma and its precursor lesions are needed for resource‐poor settings in which cervical carcinoma... Noncytologic methods of screening for cervical carcinoma and its precursor lesions are needed for resource-poor settings in which cervical carcinoma continues... BACKGROUNDNoncytologic methods of screening for cervical carcinoma and its precursor lesions are needed for resource-poor settings in which cervical carcinoma... |
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SubjectTerms | 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 |
Title | Evaluation of alternative methods of cervical cancer screening for resource‐poor settings |
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