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Comparative study of four candidate strategies to detect cervical cancer in different health care settings
Author(s) -
Kamal Meherbano M.,
Sapkal Rekha U.,
Sarodey Chhaya S.,
Munshi Maitreyee M.,
Alsi Yamini D.,
Chande Mrudul A.,
Hingway Sneha R.,
Dandige Seema,
Kane Utpala S.,
Kshirsagar Ragini,
Tangsale Madhvi,
Zodpey Sanjay,
Patel Archana B.,
Mamtani Manju,
Kulkarni Hemant
Publication year - 2007
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/j.1447-0756.2007.00562.x
Subject(s) - medicine , colposcopy , cervix , receiver operating characteristic , cervical cancer , cervical cancer screening , obstetrics , diagnostic odds ratio , pap test , cancer , cancer screening , visual inspection , gynecology , statistics , mathematics
Aim: Considering the differing but potentially supplementary properties of visual inspection of the cervix with acetic acid (VIA) and the cytological examination (CYTO) of cervical smears for the screening of cervical cancers, we examined the performance of these two tests and their combinations for the screening of cervical cancer in different health care settings. Methods: In this cross‐sectional diagnostic test performance evaluation study of 4235 female subjects in the reproductive age group, we assessed the screening performance of four strategies: VIA alone, CYTO alone, VIA and CYTO combined in a parallel fashion, and VIA and CYTO combined in tandem. Subjects were recruited from three settings: Hospital, Urban Community and Rural Community. Colposcopy was used as the reference standard. Screening performance was assessed using sensitivity, specificity, post‐test probabilities and likelihood ratios (LR), diagnostic odds, area under receiver operating characteristic curve and LR χ 2 . Results: Both VIA and CYTO when used alone had a low sensitivity but high specificity, especially in the Rural Community setting. A combination of the results of VIA and CYTO improved the diagnostic accuracy but the strategy using a parallel combination of VIA and CYTO was the most accurate. In general, all screening strategies using VIA and CYTO showed a modest screening performance. Conclusions: In the settings of varying levels of health care and low resources, caution is needed for a generalized use of VIA for cervical cancer screening. Further evaluation of the cost‐effective ways of combining VIA and CYTO is needed in these circumstances.