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- Title
Evaluation of human-papillomavirus testing and visual inspection for cervical cancer screening in Rwanda.
- Authors
Umulisa, M. Chantal; Franceschi, Silvia; Baussano, Iacopo; Tenet, Vanessa; Uwimbabazi, Mathilde; Rugwizangoga, Belson; Heideman, Daniëlle A. M.; Uyterlinde, Anne M.; Darragh, Teresa M.; Snijders, Peter J. F.; Sayinzoga, Felix; Clifford, Gary M.
- Abstract
<bold>Background: </bold>A pilot screening campaign in Rwanda, based on careHPV-testing followed by visual inspection with acetic acid triage (careHPV+VIA triage), was evaluated against other WHO-recommended screening options, namely HPV screen-and-treat and VIA screen-and-treat.<bold>Methods: </bold>764 women aged 30-69 underwent at visit 1: i) VIA, and cervical cell collection for ii) careHPV in Rwanda, and iii) liquid-based cytology and GP5+/6+ HR-HPV PCR in The Netherlands. All 177 women positive by VIA, careHPV and/or PCR were recalled, of whom 84% attended. At visit 2, VIA was again used to triage screen-positive women for treatment and to obtain biopsies from all women either from visible lesions or at 12 o'clock of the squamocolumnar junction. Cross-sectional screening indices were estimated primarily against histological high-grade squamous intraepithelial lesions or worse (hHSIL+), after imputation of missing histology data, based on 1-visit or 2-visit approaches.<bold>Results: </bold>In a 1-visit screen-and-treat approach, VIA had sensitivity and specificity of 41% and 96%, respectively, versus 71% and 88% for careHPV, and 88% and 86% for PCR. In a 2-visit approach (in which hHSIL+ imputed among women without visit 2 were considered untreated) careHPV sensitivity dropped to 59% due to loss of 13% of hHSIL+. For careHPV+VIA triage, sensitivity dropped further to 35%, as another 24% of hHSIL+ were triaged to no treatment.<bold>Conclusions: </bold>CareHPV was not as sensitive as gold-standard PCR, but detected considerably more hHSIL+ than VIA. However, due to careHPV-positive hHSIL+ women being lost to follow-up and/or triaged to no treatment, 2-visit careHPV+VIA triage did not perform better than VIA screen-and-treat.
- Subjects
CERVICAL cancer; CANCER diagnosis; PAPILLOMAVIRUSES; PUBLIC health; ONCOGENIC DNA viruses
- Publication
BMC Women's Health, 2018, Vol 18, Issue 1, pN.PAG
- ISSN
1472-6874
- Publication type
journal article
- DOI
10.1186/s12905-018-0549-5