Effectiveness of Visual Inspection with Acetic Acid (VIA) Screening on Cervical Cancer Mortality and Incidence - A Systematic Review and Meta-Analysis.

Ayush Lohiya,Roy Daniel,Cherian Varghese,Rizwan S.A,Baridalyne Nongkynrih,Durgesh Kumar,Rama Rath

doi:10.31557/apjcp.2022.23.2.399

Abstract

Objectives:Despite being a cheap, easy, and commonly used technique for screening early development of cervical cancer, collective evidence on the effect of visual inspection with acetic acid (VIA) for reducing cervical cancer mortality and incidence are conflicting. We conducted a systematic review and meta-analysis to determine the effectiveness of VIA screening on cervical cancer mortality and incidence. Methods:We searched PubMed, Embase, Cochrane library (Cochrane Database of Systematic Reviews & Cochrane Central Register of Controlled Trials), World Health Organization’s (WHO) International Clinical Trials Registry Platform, and Google Scholar to identify studies conducted among women with no history of cervical cancer that assessed effectiveness of VIA on the cervical cancer mortality and incidence. Random effects model was used to estimate incident rate ratio and sensitivity analysis was conducted using Bayesian methods. Results:Of the included 4 studies, three were cluster randomized trials from India and one was quasi-experimental study done in Thailand. Duration of follow-up ranged from 7 to 12 years. Based on 3 trials, pooled rate-ratio for cervical cancer mortality and all-cause mortality was 0.68 (95% CI: 0.56–0.81, I2=0%) and 0.91 (0.85–0.97, I2=57%), respectively. Pooled rate-ratio of invasive cervical cancer was 0.94 (95% CI: 0.67 – 1.30, I2=84%). Likewise, there was non-significant reduction in incidence of stage IB, >=stage II, and unknown stage cervical cancer. Conclusions:VIA screening may lead to reduction in cervical cancer and all-cause mortality in long run. However, the effectiveness of VIA in preventing invasive cervical cancer is inconclusive.

Highlights

Cervical cancer is the fourth most common cancer in women (Cervical cancer statistics) with an age-standardised global estimated incidence of 13.1 per 100,000 women in 2018 (Arbyn et al, 2020)
Selection criteria Inclusion criteria were: 1) Study population being women with no history of cervical cancer, 2) intervention or exposure group received screening for cervical cancer by visual inspection with acetic acid (VIA) method, 3) any study design that has a comparator groups to assess the effect of cervical cancer screening 4) comparator group received standard care, 5) sufficient data was available in the article to calculate incident rate ratio for incidence and mortality, and 6) studies in English language or a summary in English
Statistical analysis We provided summary estimates of incident rate ratio for mortality and incidence of various stages of cervical cancer and used 95% confidence interval (CI) to gauge the precision of the summary estimates

Summary

Introduction

Cervical cancer is the fourth most common cancer in women (Cervical cancer statistics) with an age-standardised global estimated incidence of 13.1 per 100,000 women in 2018 (Arbyn et al, 2020). Countries that were successful in implementing a national screening program using cytology (Pap test) showed reduction in the cervical cancer mortality and incidence (Laara et al, 1987; Aklimunnessae et al, 2006; Maine et al, 2011; Landy et al, 2016). HPV-DNA testing showed very high sensitivity and specificity for screening cervical cancer (Kuhn et al, 2000; Koliopoulos et al, 2017; Sangrajrang et al, 2017; Thomsen et al, 2020). Cytology and HPV-DNA testing have shown promising results for cervical cancer screening (Kuhn et al, 2000; Sangrajrang et al, 2017; Thomsen et al, 2020; Laara et al, 1987; Aklimunnessae et al, 2006; Landy et al, 2016), they have faced operational challenges like high implementation and execution costs, requirement of specialist doctors, and laboratory support (WHO, 2002; Catarino et al.,2015)

Objectives

Methods

Results

Discussion

Conclusion