Cervical visual inspection with acetic acid (VIA) and oncogenic human papillomavirus screening in rural indigenous guatemalan women: Time to rethink VIA

Anne Jeffries, Consuelo M. Beck-Sagué, Ariel Bernardo Marroquin-Garcia, Michael Dean, Virginia McCoy, Diego Aurelio Cordova-Toma, Eric Fenkl, Purnima Madhivanan

Research output: Contribution to journalArticlepeer-review

Abstract

Single-visit “screen-and-treat” strategies using visual inspection with acetic acid (VIA) and cryotherapy (liquid nitrous oxide ablation) in low-resource settings are commonly used to de-tect and treat precancerous lesions for cervical cancer prevention. This study compared VIA sensi-tivity and specificity in rural indigenous Guatemalan communities, to that of oncogenic human papillomavirus (HPV) testing for detection of precancerous changes, using cytology as the reference standard. Between 3–8 September 2017, trained nurses examined 222 women aged 23–58 years with VIA. Specimens for liquid-based cytology and HPV testing were obtained prior to VIA with a cyto-brush and transported in PreservCyt to a US clinical laboratory. VIA and HPV test sensitivities were assessed as proportions of women with abnormal cytology that had abnormal VIA or HPV results, respectively, and specificities, as proportions with normal cytology with normal VIA or negative HPV tests. Of 222 women, 18 (8.1%) had abnormal cytology (1 carcinoma in a participant who received VIA-based cryotherapy in 2015, 4 high-and 5 low-grade squamous intraepithelial lesions, and 8 atypical squamous cells of undetermined significance (ASCUS)). Excluding ASCUS, sensitivities of VIA and HPV were 20.0% and 100%, respectively. VIA-based screening may not be accepta-ble for detecting precancerous lesions, and field cryotherapy for preventing malignancy. The World Health Organization recommended in 2021 “…using HPV DNA detection as the primary screening test rather than VIA or cytology.”.

Original languageEnglish (US)
Article number12406
JournalInternational journal of environmental research and public health
Volume18
Issue number23
DOIs
StatePublished - Dec 1 2021

Keywords

  • Cervical cancer screening
  • Cryotherapy
  • Cy-tology
  • Guatemala
  • Human papillomavirus
  • Low-and middle-income countries
  • Low-resource settings
  • Visual inspection with acetic acid

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

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