title: Visual inspection methods for cervical cancer prevention.
abstract: The need for simple, cost-effective screening approaches for cervical cancer prevention in low-resource countries has led to the evaluation of visual screening with 3-5% acetic acid. The low reproducibility and wide variation in accuracy reflect the subjective nature of the test. Pooled sensitivity, specificity, positive and negative predictive values were 80%, 92%, 10% and 99%, respectively, for detecting cervical intraepithelial neoplasia grade 2 or worse lesions. Realistic sensitivity of a quality- assured single visual inspection with acetic acid is around 50%. A single round of visual inspection with acetic acid screening has been associated with a 25-35% reduction in cervical cancer incidence and the frequency of cervical intraepithelial neoplasia grade 2 or worse lesions in randomised-controlled trials. Despite all its limitations, implementing visual inspection with acetic acid screening in low-resource countries may provide a pragmatic approach to building up human resources and infrastructure that may facilitate the highly anticipated low-cost, rapid human papilloma virus testing in the near future.
authors.affiliation: Early Detection and Prevention Section and Screening Group, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France. sankar@iarc.fr
authors.forename: Rengaswamy
authors.initials: R
authors.lastname: Sankaranarayanan
authors.forename: Ashrafun
authors.initials: A
authors.lastname: Nessa
authors.forename: Pulikattil Okkuru
authors.initials: PO
authors.lastname: Esmy
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Dangou
mesh_terms: D019342:Acetic Acid / Q000191:economics; D002819:Chorea; D003906:Developing Countries; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D007454:Iodides; D008661:Metabolism, Inborn Errors; D009896:Optic Atrophy; D015203:Reproducibility of Results; D015419:Spastic Paraplegia, Hereditary; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology
chemical_list: D007454:Iodides; D019342:Acetic Acid; C010389:Lugol's solution