Cervical Visual Inspection with Acetic Acid (VIA) and Oncogenic Human Papillomavirus Screening in Rural Indigenous Guatemalan Women: Time to Rethink VIA.

Diego Aurelio Cordova-Toma,Consuelo M. Beck-Sagué,Anne Jeffries,Virginia McCoy,Ariel Bernardo Marroquin-Garcia,Michael Dean,Eric Fenkl,Purnima Madhivanan

doi:10.3390/ijerph182312406

Abstract

Single-visit “screen-and-treat” strategies using visual inspection with acetic acid (VIA) and cryotherapy (liquid nitrous oxide ablation) in low-resource settings are commonly used to detect and treat precancerous lesions for cervical cancer prevention. This study compared VIA sensitivity and specificity in rural indigenous Guatemalan communities, to that of oncogenic human papillomavirus (HPV) testing for detection of precancerous changes, using cytology as the reference standard. Between 3–8 September 2017, trained nurses examined 222 women aged 23–58 years with VIA. Specimens for liquid-based cytology and HPV testing were obtained prior to VIA with a cytobrush and transported in PreservCyt to a US clinical laboratory. VIA and HPV test sensitivities were assessed as proportions of women with abnormal cytology that had abnormal VIA or HPV results, respectively, and specificities, as proportions with normal cytology with normal VIA or negative HPV tests. Of 222 women, 18 (8.1%) had abnormal cytology (1 carcinoma in a participant who received VIA-based cryotherapy in 2015, 4 high- and 5 low-grade squamous intraepithelial lesions, and 8 atypical squamous cells of undetermined significance (ASCUS)). Excluding ASCUS, sensitivities of VIA and HPV were 20.0% and 100%, respectively. VIA-based screening may not be acceptable for detecting precancerous lesions, and field cryotherapy for preventing malignancy. The World Health Organization recommended in 2021 “…using HPV DNA detection as the primary screening test rather than VIA or cytology”.

Highlights

Parity ranged from 1–12 deliveries, and 96% had delivered at least 1 child; 11 (4.9%; 95% CI = 2.5–8.7%) of visual inspection with acetic acid (VIA) examinations were considered abnormal, including 1 with a lesion consistent with cancer, in a woman who had had VIA and cryotherapy in 2015
These findings suggested that alternatives to VIA should be sought, and that human papillomavirus (HPV)
Our study suggested that VIA-based screening with cryotherapy may miss women with treatable precancerous lesions

Summary

Introduction

Cervical cancer incidence and mortality declined in high-income countries with the widespread use of cytological screening and treatment of precancerous lesions [1]. Detection and treatment can prevent progression of precancerous lesions to cancer, preserving life and fertility. Oncogenic human papillomavirus (HPV) types are present in. 95–100% of cervical cancer specimens and cause most cases of cervical cancer [2]. The. Latin America and Caribbean (LAC) region is home to just 9% of the world population but bears approximately 16% of the world cervical cancer mortality [3,4]. Low access to screening and treatment, in remote rural populations, are important barriers to timely detection and treatment. Cervical cancer mortality in Guatemala is the leading

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Discussion

Conclusion