Reference Manual - IARC Screening Group

Introductiontheir performance was training. During a week-long, competency-basedtraining course, participants used a specially designed VIA cervical atlasand practiced VIA on pelvic models before working with patients. Duringthe first few months of the project, the nurse-midwives also receivedsupplemental training in the work setting.Since these initial studies were conducted and their results published, alarge group of subsequent studies has been conducted, many of thesebuilding on the information and design innovations that were present inthe studies mentioned above. A summary article of evidence to date citedmultiple studies that report the test qualities of VIA (Gaffikin, 2003). Itwas suggested that VIA is comparable to the Pap test as a cervical cancerscreening tool. A large study by Denny et al. (2002) “confirmed theutility of DVI [direct visual inspection of the cervix after the applicationof 5% acetic acid] as a primary screening test.” Similarly, the results of astudy by Rodriguez-Reyes et al. (2002) revealed a high sensitivity andnegative predictive value for CIN I and CIN II using the acetic acid test(AAT). Gaffikin et al. (2003) furthermore emphasized the research thatsupports the potential usefulness of VIA in low-resource settings. In theirstudy, Singh et al. (2001) also concluded “screening for cervicalprecancerous and cancerous lesions using visual inspection aided byacetic acid may be a suitable low-cost and a feasible alternative modalityfor control of cervical cancer in a resource poor setting.” Further, as aresult of all of these studies, a variety of professional organizations—including the American College of Obstetricians and Gynecologists, theRoyal College of Obstetricians and Gynaecologists, the Canadian Societyof Obstetricians and Gynecologists and the International Federation ofGynecology and Obstetrics (FIGO)—have all endorsed VIA as a viableoption for screening in low-resource settings (ACOG 2004).Table 1-4 summarizes the results of a number of VIA test quality studiesperformed to date that confirm the usefulness of VIA as a screening tool inlow-resource settings. Based on the results of these studies, VIA has beencharacterized as a proven, simple alternative for identifying women withprecancerous cervical lesions (Kitchener and Symonds 1999; Parkin andSankaranarayanan 1999; Sankaranarayanan, Budukh and Rajkumar 2001).Cervical Cancer Prevention Guidelines for Low-Resource Settings 1-9