Comparison between visual inspection of cervix and cytology based screening procedures in Bangladesh.
BACKGROUND
Cervical cancer continues to be a major problem in Bangladesh with approximately 18,000 new cases annually of which over 10,000 women die from it. Visual inspection of the cervix after 3-5% acetic acid (VIA) application is a simple and easy to learn method for cervical cancer screening, although cytology-based screening is more often applied in developed countries where it has successfully reduced the prevalence of cervical cancer.


OBJECTIVE
To compare the efficacy of VIA and cytology-based primary methods for cervical cancer screening in Bangladesh.


METHODS
This hospital based comparative study was conducted at the VIA centre and Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) from October 2008 to October 2010.


RESULTS
Among 650 women, 74 (11.4%) were VIA+ve and 8 (1.2%) had abnormalities in their Pap smear reports. During colposcopy, 38 (7.7%) women had different grades of CIN and 4 (0.6%) had cervical cancer. The gold standard histology findings proved 20 women had CIN I, 14 had CIN II/II and 4 had cervical cancer. Among the 38 histology diagnosed abnormalities, VIA test could identify 30 abnormalities including two cervical cancers. However, Pap smear could detect only 8 cases of histological abnormalities (2 low grade and 6 had high grade lesion) and it missed all the cervical cancer cases. The sensitivity and specificity of VIA were 88.9% and 52.1%. The positive predictive value (PPV) and negative predictive value (NPV) were 41.0%, and 92.6% respectively. Moreover, the sensitivity, specificity, PPV and NPV of Pap smear were 33.3%, 95.8%, 75.0% and 79.3%, respectively.


CONCLUSIONS
VIA test should be used as the primary screening tool even with its low sensitivity and specificity in low resource countries like Bangladesh. False positive results may be greater, but overtreatment can be minimized by colposcopy evaluation of the VIA positive women.
Gyne-oncology Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh E-mail : ashra58@yahoo.co.uk.
Ashrafun
A
Nessa
Khadiza Nurun
KN
Nahar
Shirin Akhter
SA
Begum
Shahin Ara
SA
Anwary
Fawzia
F
Hossain
Khairun
K
Nahar
D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy; D003581:Cytodiagnosis; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D065006:Papanicolaou Test; D011379:Prognosis; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult