Title: Comparative study of four candidate strategies to detect cervical cancer in different health care settings.

POPLINE Document Number: 313766

Author(s):

Kamal MM
Sapkal RU
Sarodey CS
Munshi MM
Alsi YD

Source citation:

Journal of Obstetrics and Gynaecology Research, 2007 Aug;33(4):480-489.

Abstract:

Considering the differing but potentially supplementary properties of visual inspection of the cervix with acetic acid (VIA) and the cytological examination (CYTO) of cervical smears for the screening of cervical cancers, we examined the performance of these two tests and their combinations for the screening of cervical cancer in different health care settings. In this cross-sectional diagnostic test performance evaluation study of 4235 female subjects in the reproductive age group, we assessed the screening performance of four strategies: VIA alone, CYTO alone, VIA and CYTO combined in a parallel fashion, and VIA and CYTO combined in tandem. Subjects were recruited from three settings: Hospital, Urban Community and Rural Community. Colposcopy was used as the reference standard. Screening performance was assessed using sensitivity, specificity, post-test probabilities and likelihood ratios (LR), diagnostic odds, area under receiver operating characteristic curve and LR x/2. Both VIA and CYTO when used alone had a low sensitivity but high specificity, especially in the Rural Community setting. A combination of the results of VIA and CYTO improved the diagnostic accuracy but the strategy using a parallel combination of VIA and CYTO was the most accurate. In general, all screening strategies using VIA and CYTO showed a modest screening performance. In the settings of varying levels of health care and low resources, caution is needed for a generalized use of VIA for cervical cancer screening. Further evaluation of the cost-effective ways of combining VIA and CYTO is needed in these circumstances. (author's)

Keywords:

Developing Countries
Research Report
Comparative Studies
Cross Sectional Analysis
Cervical Cancer
Cytology
Colposcopy
Examinations and Diagnoses
Testing
Screening
Cost Effectiveness
Studies
Research Methodology
Cancer
Neoplasms
Diseases
Biology
Endoscopy
Physical Examinations and Diagnoses
Medical Procedures
Medicine
Health Services
Delivery of Health Care
Health
Measurement
Evaluation Indexes
Quantitative Evaluation
Evaluation