Evaluation of a cervical cancer screening program based on HPV testing and LLETZ excision in a low resource setting

McAdam, Margaret, Sakita, Jerol, Tarivonda, Len, Pang, James and Frazer, Ian H. (2010) Evaluation of a cervical cancer screening program based on HPV testing and LLETZ excision in a low resource setting. PLoS One, 5 10: e13266.1-e13266.6. doi:10.1371/journal.pone.0013266

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Author McAdam, Margaret
Sakita, Jerol
Tarivonda, Len
Pang, James
Frazer, Ian H.
Title Evaluation of a cervical cancer screening program based on HPV testing and LLETZ excision in a low resource setting
Journal name PLoS One   Check publisher's open access policy
ISSN 1932-6203
Publication date 2010-10
Sub-type Article (original research)
DOI 10.1371/journal.pone.0013266
Open Access Status DOI
Volume 5
Issue 10
Start page e13266.1
End page e13266.6
Total pages 6
Place of publication San Francisco, CA, United States
Publisher Public Library of Science
Collection year 2011
Language eng
Abstract We conducted studies in Vanuatu to evaluate potential screening and treatment strategies to assist with control of cervical cancer. In a pilot study of 496 women, visual inspection and cytology were evaluated as screening tests for detection of CIN 2 or worse (CIN2+), observed in 21 of 206 subjects biopsied on the basis of abnormal visual inspection or cytology. Sensitivity of visual inspection with Lugol's Iodine for detection of CIN2+ on biopsy was 0.63, specificity was 0.32, and the positive predictive value was 0.09. For HSIL cytology, sensitivity was 0.99, specificity was 0.77, and the positive predictive value was 0.88. HSIL cytology was significantly more sensitive and had a significantly higher PPV for CIN 2+ than visual inspection (p<0.01). In a further study of 514 women, we compared testing for HR HPV and cytology as predictors of biopsy proven CIN 2+. Sensitivity of HSIL cytology for CIN2+ as established by loop excision of the cervix was 0.81, specificity was 0.94, and positive predictive value was 0.48. Sensitivity of a positive test for HR HPV for detection of CIN2+ was nonsignificantly different from cytology at 0.81, specificity was 0.94, and positive predictive value was 0.42. Combining the two tests gave a significantly lower sensitivity of 0.63, a specificity of 0.98, and a positive predictive value of 0.68. For women over 30 in a low resource setting without access to cytology, a single locally conduced test for high risk HPV with effective intervention could reduce cervical cancer risk as effectively as intervention based on cytology conducted in an accredited laboratory.
Keyword Human-papillomavirus
Lesion size
Rural India
Neoplasia
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article # e13266

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
UQ Diamantina Institute - Open Access Collection
UQ Diamantina Institute Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 6 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 10 times in Scopus Article | Citations
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Created: Sun, 24 Oct 2010, 00:03:42 EST