Visual inspection with acetic acid for cervical cancer screening outside of low-resource settings La inspección visual con ácido acético para el tamizaje del cáncer cervicouterino donde no hay escasez de recursos

• Main Authors: Jose Jeronimo, Orlando Morales, Jorge Horna, José Pariona, Javier Manrique, Jorge Rubiños, Rina Takahashi
• Format: Article in Journal/Newspaper
• Language: English; Spanish; Portuguese
• Published: Pan American Health Organization 2005
• Subjects: Neoplasmas del cuello uterino; ácido acético; técnicas y procedimientos diagnósticos; tamizaje masivo; valor predictivo de los tests; recursos en salud; Cervix neoplasms; acetic acid; diagnostic techniques and procedures; mass screening; predictive value of tests; health resources; Medicine; R; Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic
• Online Access: https://doaj.org/article/d05be8d54fe842b3a9e9685677c4fdbb

OBJECTIVES: 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. OBJETIVOS: Determinar si la inspección visual con ácido acético (IVAA) es útil como prueba de tamizaje en un centro de salud peruano con buena dotación de equipo; si se presta para uso en lugar del Papanicolaou o en combinación con él, y si tiene alguna utilidad en lugares donde no hay ...