Evaluation of a Cervical Cancer Screening Program Based on HPV Testing and LLETZ Excision in a Low Resource Setting

• Published in: PloS one Vol. 5; no. 10; p. e13266
• Main Authors: McAdam, Margaret, Sakita, Jerol, Tarivonda, Len, Pang, James, Frazer, Ian H.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.10.2010; Public Library of Science (PLoS)
• Subjects: Adult; Age; Alphapapillomavirus - isolation & purification; Biopsy; Cancer; Cancer prevention; Cancer research; Cancer screening; Cellular biology; Cervical cancer; Clinical medicine; Consent; Cytology; Deoxyribonucleic acid; Disease prevention; DNA; Family medical history; Female; Genetic testing; Health aspects; Health care; Health risks; Human papillomavirus; Humans; Infections; Inspection; Intervention; Iodine; Lugol's iodine; Mass Screening - standards; Medical screening; Medical tests; Middle Aged; Oncology/Genitourinary Cancers; Pathology; Public health; Public Health and Epidemiology/Preventive Medicine; Risk factors; Sensitivity; Sensitivity and Specificity; Statistical analysis; Testing laboratories; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - virology; Vaccines; Virology/Viruses and Cancer; Womens health; Queensland Australia; Australia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0013266

We conducted studies in Vanuatu to evaluate potential screening and treatment strategies to assist with control of cervical cancer. In a pilot study of 496 women, visual inspection and cytology were evaluated as screening tests for detection of CIN 2 or worse (CIN2+), observed in 21 of 206 subjects biopsied on the basis of abnormal visual inspection or cytology. Sensitivity of visual inspection with Lugol's Iodine for detection of CIN2+ on biopsy was 0.63, specificity was 0.32, and the positive predictive value was 0.09. For HSIL cytology, sensitivity was 0.99, specificity was 0.77, and the positive predictive value was 0.88. HSIL cytology was significantly more sensitive and had a significantly higher PPV for CIN 2+ than visual inspection (p<0.01). In a further study of 514 women, we compared testing for HR HPV and cytology as predictors of biopsy proven CIN 2+. Sensitivity of HSIL cytology for CIN2+ as established by loop excision of the cervix was 0.81, specificity was 0.94, and positive predictive value was 0.48. Sensitivity of a positive test for HR HPV for detection of CIN2+ was non-significantly different from cytology at 0.81, specificity was 0.94, and positive predictive value was 0.42. Combining the two tests gave a significantly lower sensitivity of 0.63, a specificity of 0.98, and a positive predictive value of 0.68. For women over 30 in a low resource setting without access to cytology, a single locally conducted test for high risk HPV with effective intervention could reduce cervical cancer risk as effectively as intervention based on cytology conducted in an accredited laboratory.