title: Visual inspection with acetic acid for cervical cancer screening outside of low-resource settings.
abstract: OBJECTIVE
  To assess visual inspection with acetic acid (VIA) as a screening tool for use in a well-equipped health center in Peru, to evaluate VIA as an alternative or adjunct to the Papanicolaou (Pap) smear, and to determine if VIA can play a role in settings other than low-resource ones.
  
  
  METHODS
  This was a prospective study of 1 921 asymptomatic women living in Lima, Peru, carried out in 1999 and 2000. The study was performed at a cancer center equipped with the latest-generation technology and highly trained oncologists. The women underwent a complete clinical evaluation, including a Pap smear and VIA. Participants with any positive test were referred for colposcopy and biopsy.
  
  
  RESULTS
  More women tested positive by VIA than on the Pap smear (6.9% vs. 4.2%; P = 0.0001). There were 35 women with histologic cervical intraepithelial neoplasia grade 1 (CIN 1); of these, 15 were detected by Pap and 20 by VIA (P = 0.4). A diagnosis of CIN 2 or 3 (CIN 2-3) was confirmed in a total of 13 cases; Pap detected 5 of the cases and VIA 11 of the cases (P = 0.06). The positive predictive value for detection of CIN 2+ was 8.3% for VIA and 6.3% for Pap (P = 0.5). Most importantly, while only 2.3% of patients with a positive VIA were lost to follow-up before colposcopy, that was true for 26.3% of the women with a positive Pap smear (P < 0.0001).
  
  
  CONCLUSIONS
  VIA is useful for detection of precursor lesions of cervical cancer not only in low-resource settings but also in well-equipped health centers and cancer centers. In these non-low-resource settings, VIA has a positive predictive value comparable to the conventional Pap smear, but it is more likely to achieve earlier diagnosis, follow-up, and treatment than cytology-based screening.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, National Institutes of Health, Rockville, Maryland, USA. guibovij@mail.nih.gov
authors.forename: Jose
authors.initials: J
authors.lastname: Jeronimo
authors.forename: Orlando
authors.initials: O
authors.lastname: Morales
authors.forename: Jorge
authors.initials: J
authors.lastname: Horna
authors.forename: José
authors.initials: J
authors.lastname: Pariona
authors.forename: Javier
authors.initials: J
authors.lastname: Manrique
authors.forename: Jorge
authors.initials: J
authors.lastname: Rubiños
authors.forename: Rina
authors.initials: R
authors.lastname: Takahashi
mesh_terms: D019342:Acetic Acid; D000328:Adult; D003127:Colposcopy; D005260:Female; D006801:Humans; D007202:Indicators and Reagents; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D065006:Papanicolaou Test; D011237:Predictive Value of Tests; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid