title: Acetic-acid guided visual inspection vs. cytology-based screening for cervical cancer in the Philippines.
abstract: OBJECTIVE
  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 12992 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.
authors.affiliation: University of the Philippines Department of Health, Cervical Cancer Screening Health Operations Study Group, National Institutes of Health, Pedro Gil, Ermita, Manila, Philippines.
authors.forename: C A
authors.initials: CA
authors.lastname: Ngelangel
authors.forename: G M
authors.initials: GM
authors.lastname: Limson
authors.forename: C P
authors.initials: CP
authors.lastname: Cordero
authors.forename: A D
authors.initials: AD
authors.lastname: Abelardo
authors.forename: J M
authors.initials: JM
authors.lastname: Avila
authors.forename: M R
authors.initials: MR
authors.lastname: Festin
mesh_terms: D019342:Acetic Acid; D000328:Adult; D001290:Attitude; D001706:Biopsy; D003127:Colposcopy / Q000379:methods; D005260:Female; D006801:Humans; D007202:Indicators and Reagents / Q000494:pharmacology*; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D065006:Papanicolaou Test; D010679:Philippines; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears / Q000379:methods*
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid