Abstract
BackgroundScreening of unvaccinated women remains essential to mitigate the high morbidity/mortality of cervical cancer. Here, we compared visual inspection with acetic acid (VIA), recommended by WHO as the most cost-effective screening approach in LMICs, with HPV-based screening, and usage of p16INK4a/Ki-67 dual stain cytology.MethodsWe prospectively enrolled women participating in a VIA-based cervical cancer screening program in two peri-urban health centers of Kenya. Consenting women had a VIA examination preceded by collection of a liquid-based cytology sample from the cervix stored in PreservCyt medium (Hologic®). Analysis of all samples included a hrHPV DNA test and evaluation of a p16INK4a /Ki-67 (CINtecPLUS®) dual stained slide that was prepared using the ThinPrep® 2000 Processor and evaluated by a pathologist trained in the methodology.ResultsIn 701 of a total of 800 women aged 18–64 years, all three investigations were performed and data could be analyzed. The HPV, VIA and dual stain cytology positivity were 33%, 7%, and 2% respectively. The HPV positivity rate of VIA positive cases was 32%. The five most common HPV types were HPV16, 52, 68, 58 and 35. The OR among HIV infected women of an HPV infection, VIA positivity and positive dual stain cytology were 2.6 (95%CI 1.5–4.3), 1.9 (95%CI 0.89–4.4) and 3.4 (95%CI 1.07–10.9) respectively. The sensitivity of VIA to detect a p16INK4a/Ki-67 positive transforming infection was 13% (95%CI 2–38).ConclusionsPrimary HPV testing appears feasible and should be considered as a primary screening test also in LMICs. The poor sensitivity of VIA renders it unsuitable as a triage test for HPV positive women. The utility of p16INK4a/Ki-67 dual stain cytology as a triage test for HPV positive women in LMICs should be further studied.
Highlights
IntroductionCancer of the uterine cervix (cervical cancer) is the leading cancer in women in Sub-Sahara Africa [1]
Cancer of the uterine cervix is the leading cancer in women in Sub-Sahara Africa [1]
New cervical cancer cases can be effectively reduced by screening tests that allow for the early detection and subsequent treatment of pre-cancerous lesions [2] and by vaccination against human papillomavirus (HPV) infection [3]
Summary
Cancer of the uterine cervix (cervical cancer) is the leading cancer in women in Sub-Sahara Africa [1]. The most impressive screening results were achieved in industrialized countries by regular cytological assessment of the cervix using the Pap test [6, 7]. This test is not considered suitable for screening in developing countries as it requires highly specialized personnel for evaluation and a reliable infrastructure for regular retesting due to the limited specificity and sensitivity profiles and high rates of equivocal results of the Pap test [8, 9]. We compared visual inspection with acetic acid (VIA), recommended by WHO as the most cost-effective screening approach in LMICs, with HPV-based screening, and usage of p16INK4a/Ki-67 dual stain cytology
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