Abstract
BackgroundVisual inspection of the cervix after application of 5% acetic acid (VIA) is a screening technique for cervical cancer used widely in low and middle-income countries (LMIC). To improve VIA screening performance, digital images after acid acetic application (D-VIA) are taken. The aim of this study was to evaluate the use of a smartphone for on- and off-site D-VIA diagnosis.Materials and MethodsWomen aged 30–65 years, living in the city of Ambanja, Madagascar, were recruited through a cervical cancer screening campaign. Each performed a human papillomavirus (HPV) self-sample as a primary screen. Women testing positive for HPV were referred for VIA followed by D-VIA, cervical biopsy and endocervical curettage according to routine protocol. In addition, the same day, the D-VIA was emailed to a tertiary care center for immediate assessment. Results were scored as either D-VIA normal or D-VIA abnormal, requiring immediate therapy or referral to a tertiary center. Each of the three off-site physicians were blinded to the result reported by the one on-site physician and each gave their individual assessment followed by a consensus diagnosis. Statistical analyses were conducted using STATA software.ResultsOf the 332 women recruited, 137 (41.2%) were HPV-positive and recalled for VIA triage; compliance with this invitation was 69.3% (n = 95). Cervical intraepithelial neoplasia was detected in 17.7% and 21.7% of digital images by on-site and off-site physicians, respectively. The on-site physician had a sensitivity of 66.7% (95%CI: 30.0–90.3) and a specificity of 85.7% (95%CI: 76.7–91.6); the off-site physician consensus sensitivity was 66.7% (95%CI: 30.0–90.3) with a specificity of 82.3% (95%CI: 72.4–89.1).ConclusionThis pilot study supports the use of telemedicine for off-site diagnosis of cervical intraepithelial neoplasia, with diagnostic performance similar to those achieved on-site. Further studies need to determine if smartphones can improve cervical cancer screening efficiency in LMIC.
Highlights
In Madagascar there are 3,194 new cervical cancer cases diagnosed every year and, according to country statistics, 1,804 women died of cervical cancer, making cervical cancer a leading cause of cancer death in females [1]
Women testing positive for human papillomavirus (HPV) were referred for visual inspection with acetic acid (VIA) followed by D-VIA, cervical biopsy and endocervical curettage according to routine protocol
Smartphone Use for Cervical Cancer Screening. This pilot study supports the use of telemedicine for off-site diagnosis of cervical intraepithelial neoplasia, with diagnostic performance similar to those achieved on-site
Summary
In Madagascar there are 3,194 new cervical cancer cases diagnosed every year and, according to country statistics, 1,804 women died of cervical cancer (estimations for 2012), making cervical cancer a leading cause of cancer death in females [1]. In Western countries, cervical cancer can be prevented through cytology-based screening, but for low and middleincome countries (LMIC), large-scale screening is yet to be implemented, essentially because of a lack of human and material resources. To overcome barriers associated with the implementation of screening programs in LMIC, the World Health Organization has recommended cervical visual inspection with acetic acid (VIA), which is low cost, easy to perform and offers the possibility of immediate treatment, if needed [2]. Developing strategies to facilitate training and supervision for novice healthcare professional in underserved areas is essential to reduce false-positive rates and increase detection of real positive cases. Visual inspection of the cervix after application of 5% acetic acid (VIA) is a screening technique for cervical cancer used widely in low and middle-income countries (LMIC). Editor: Marcia Edilaine Lopes Consolaro, State University of Maringá/Universidade Estadual de Maringá, BRAZIL
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