Abstract

PIP: The reduction of cervical cancer mortality in developing countries is only one of many priorities competing for scarce funds. Incidence of cervical cancer may be up to six times higher in these countries than in developed countries due to lack of screening programs. The current WHO recommendation is to evaluate visual inspection as a way of identifying early curable cancer, as screening by cytology is too complex and expensive. Hence, an assessment of visual inspection aided by acetic acid (VIA) has been conducted in Zimbabwe. The study aimed to find out the true sensitivity, specificity, and positive predictive value (PPV) for high-grade CIN. The subject group was composed of 10,934 women screened by VIA and by exfoliative cervical cytology. The main findings of the study were that VIA was abnormal in about 20% of women; moreover, the test had a PPV of 25.9%, meaning that 3 out of 4 women would potentially be overtreated. VIA, however, represents a proven, simple means of identifying women in undeveloped health facilities, though level of training is probably critical to its success. Screening should go hand in hand with health education, which has proven valuable in reducing the rate of deaths from cervical cancer.