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Cervical cancer screening in sub‐ S aharan A frica: A randomized trial of VIA versus cytology for triage of HPV ‐positive women
Author(s) -
Bigoni Jérôme,
Gundar Mélissa,
Tebeu PierreMarie,
Bongoe Adamo,
Schäfer Sonja,
FokomDomgue Joël,
Catarino Rosa,
Tincho Evelyne Foguem,
Bougel Stéphanie,
Vassilakos Pierre,
Petignat Patrick
Publication year - 2014
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.29353
Subject(s) - cytology , medicine , cervical intraepithelial neoplasia , triage , gynecology , colposcopy , endocervical curettage , cervical cancer , obstetrics , cervix , biopsy , papillomaviridae , cancer , pathology , emergency medicine
Developing countries are interested in using human papillomavirus (HPV) testing as a primary screening test for cervical cancer prevention programs. The low specificity of the HPV assay requires triage testing of HPV‐positive women. The aim of the study is to compare visual inspection with acetic acid (VIA) and cytology as triage testing methods in HPV‐positive women to detect cervical intraepithelial neoplasia or Grade 2 or higher (CIN2+). The study was conducted in two Cameroonian towns (Yaoundé and Edea) and included 846 eligible women aged 25 to 65 years. All participants performed self‐HPV testing. HPV‐positive women ( n = 259) were randomly assigned to be tested either by VIA (VIA group) or cytology (cytology group). HPV‐positive women had both cervical biopsy and endocervical curettage to detect biopsy‐confirmed CIN2+. All statistical tests were two‐sided. The prevalence of HPV was 38.5%, and the mean age of HPV‐positive women was 41.5 ± 10.1 years. One hundred ninety‐eight women (97 in the VIA group and 99 in the cytology) were randomly assigned to one of the two testing arms. The sensitivity of VIA was 25.0% (95% CI, 7.1–59.1%), and the sensitivity of cytology was 90.0% (59.6–98.2%). The specificity was 74.2% (95% CI, 64.2–82.1%) for VIA and 85.2% (76.3–91.2%) for cytology. ROC area for cytology was 0.910 against the 0.496 area for VIA. In this trial, VIA was inferior to cytology as a triage test among HPV‐positive women. Further investigations are needed to determine the optimal triage method for HPV‐positive women.