Visual screening for early detection of cervical neoplasia in Angola.
OBJECTIVE
A cross-sectional study in Angola to evaluate the feasibility of cervical screening using visual inspection with acetic acid (VIA) or Lugol's iodine (VILI) to detect and treat cervical intraepithelial neoplasia (CIN).


METHODS
All 8851 women screened by trained nurses received colposcopy and/or colposcopically-directed biopsies. The final disease status was based on histopathology or colposcopy when no or inadequate biopsies were done. The sensitivity, specificity, and predictive values of tests to detect CIN 2-3 were calculated.


RESULTS
VIA was positive in 6.6% and VILI in 32.0% of the women. The positivity rates increased with time only for VILI. CIN 2-3 was diagnosed in 75 women and invasive cancer in 57. The sensitivity and specificity was 70.7% (95% CI, 59.0%-80.6%) and 94.5% (95% CI, 94.0%-95.0%) respectively for VIA, and 88.0% (95% CI, 78.4%-94.4%) and 68.9% (95% CI, 67.9%-69.9%) for VILI. Ninety percent of women detected with CIN received treatment. Treatment was given on the same day as screening to one-third of the 374 women treated with cryotherapy/LEEP. No major complications or adverse effects were associated with treatment.


CONCLUSIONS
It was feasible to screen with both visual tests and treat women with CIN in Angola. VILI was less specific than VIA, implying subjectivity in interpreting test results.
Muwonge
Richard
R
Screening Group, International Agency for Research on Cancer, Lyon, France. muwonger@iarc.fr
Manuel
Miraldina da Ganda
Mda G
Filipe
Antonio P
AP
Dumas
Joaquim Bernardo
JB
Frank
Margarida Ranque
MR
Sankaranarayanan
Rengaswamy
R
D019342:Acetic Acid; D000328:Adult; D000810:Angola / Q000453:epidemiology; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007454:Iodides; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy
D007454:Iodides; D019342:Acetic Acid; C010389:Lugol's solution