Effectiveness of visual inspection with acetic acid as a test for cervical cancer screening

Abstract

Objective: To assess the effectiveness of visual inspection of cervix with acetic acid (VIA test) as an accepted method for screening of cervical Cancer. Materials and Methods: Two hundred women attending the Cervical and Breast Cancer Screening Program and outpatient department (OPD) of Department of Obstetrics and Gynecology at our center were examined by both Pap smear and VIA tests. Results: Patients were aged between 21 and 70 years (mean 35.8 years). Nearly 45% got married between 16 and 20 years and 44% before 15 years of age. Oral contraceptives users were 23%. Nearly 14% of the women tested positive by VIA. Pap smear showed atypical squamous cells of undetermined significance in 9.5%, low-grade lesion in 6%, and high-grade lesions in 1.5%. Colposcopy showed cervical intraepithelial neoplasia (CIN-I) in 9%, 2% had CIN-II/III, invasive cancer in 1%, and 7% had unsatisfactory colposcopy findings. Thirty-six women required biopsy for histopathological confirmation. Among them, 7.5% had chronic cervicitis/koilocytic changes, 4.5% had CIN-I, 2% had CIN-II, 1.5% had CIN-III, 0.5% had invasive cancer, and 2% had normal result. Sensitivity of VIA was 76.5% and specificity was 91.8%. Sensitivity of Pap smear was 64.7% and specificity was 87.4%. Conclusion: Sensitivity and specificity of VIA was higher than that of Pap smear test. VIA can be used as an effective screening test to detect the precancerous and cancerous lesions of the cervix in Bangladesh.

Keywords

• Cervical cancer
• screening
• visual inspection of acetic acid