Cervical cancer and sexually transmitted diseases

OBJECTIVES

General objective:

To assess the feasibility of interventions for primary and secondary prevention interventions to improve women's reproductive health (cervical cancer screening).

Specific objective:

To validate and enhance the specificity of visual inspection (VIA) versus PAP smear.

METHODS

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

RESULTS

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