Cervical cancer and sexually transmitted diseases
To assess the feasibility of interventions for primary and secondary prevention interventions to improve women's reproductive health (cervical cancer screening).
To validate and enhance the specificity of visual inspection (VIA) versus PAP smear.
Six hundred fifty-three women, attending a family planning clinic in Nairobi (Kenya), underwent four concurrent screening methods: pap smear, visual inspection with acetic acid (VIA), PCR for high risk human papillomavirus (HR HPV) and cervicography.
The presence of cervical intra-epithelial neoplasia (CIN) was verified by colposcopy or biopsy
Sensitivity (for CIN2 or higher) and specificity (to exclude any CIN or cancer) were 83.3% (95% CI [73.6, 93.0]) and 94.6% (95% CI [92.6, 96.5]), respectively, for pap smear; 73.3% (95% CI [61.8, 84.9]) and 80.0% (95% CI [76.6, 83.4]) for VIA; 94.4% (95% CI [84.6, 98.8]) and 73.9% (95% CI [69.7, 78.2]) for HR HPV; and 72.3% (95% CI [59.1, 85.6]) and 93.2% (95% CI [90.8, 95.7]) for cervicography.
Conclusion: The pap smear had the highest specificity (94.6%) and HPV testing the highest sensitivity (94.4%). The visual methods, VIA and cervicography, were similar and showed an accuracy in between the former two tests
Results on this study were published in international journals: Int J Gynaecol Obstet. 2005 May;89(2):120-6 and Sex Transm Dis. 2003 Feb;30(2):137-42
Hugo De Vuyst, Marleen Temmerman
Job Bwayo (Department of Medical Microbiology, University of Nairobi, Kenya); Family Planning Association of Kenya