Acetic-acid guided visual inspection vs. cytology-based screening for cervical cancer in the Philippines

Abstract

Objectives: To compare the validity and acceptability of acetic-acid visualization (VIA), magnified acetic-acid visualization (VIAM), spatula+cotton swab–Papanicolaou (Pap) smear (SS), and cervical brush–Pap smear (CB) in the detection of precursor/early cervical cancer lesions. Methods: A total of 12 992 women aged between 25 and 65 years from 14 Philippine centers were randomly allocated to the four tests. The gold standard was colposcopy with biopsy for positive/suspicious cases. Results: Sensitivity rates [95% confidence intervals (CIs)] were 37 (CI, 26.8–48.5), 34.1 (CI, 24.8–44.8), 14.3 (CI, 6.4–27.8), and 19.1 (CI, 9.2–34.6) for VIA, VIAM, SS, and CB, respectively. Specificity rates were 90.7 (CI, 89.6–91.7), 90.7 (CI, 89–91.1), 97.5 (CI, 96.8–98), and 97.9 (CI, 97.3–98.4), respectively. Kappa for the Pap smear (PS) within centers ranged from −0.154 to 0.783, and between centers from −0.028 to 0.364. Screeners preferred CB; screened-women preferred VIA. Conclusions: The acetic-acid visualization and VIAM methods are recommended for initial cervical cancer screening in the Philippines.