Reference Manual - IARC Screening Group

IntroductionTable 1-4. Test Qualities of VIA when Performed as Primary Screening Method in Low-Resource SettingsSTUDY COUNTRY NUMBEROF CASESDETECTION OFHGSIL a AND CANCERSENSITIVITY bSPECIFICITY bBelinson (2001) China 1,997 71% 74%Denny et al. (2000) South Africa 2,944 67% 84%Sankaranarayanan et al. (1999) India 1,351 96% 68%University ofZimbabwe 2,148 77% 64%Zimbabwe/JHPIEGO (1999)Sankaranarayanan et al. (1998) India 2,935 90% 92%Megevand et al. (1996) South Africa 2,426 65% 98%Sankaranarayanan and Wesley(unpublished)India 2,462 84% 90%Sankaranarayanan et al. (2004) India 56,939 76.8% 85.5%aHGSIL = high-grade squamous intraepithelial lesionb Estimated from the number provided in the manuscript and does not reflect adjustment(s) for verification bias.Adapted from: Belinson et al. (2001); Denny et al. (2000); Megevand et al. (1996); Sankaranarayanan et al. (1999);Sankaranarayanan et al. (1998); Sankaranarayanan and Wesley (unpublished); and University of Zimbabwe/JHPIEGOCervical Cancer Project (1999).In summary, VIA can be considered for use in low-resource settingsbecause it:• Can effectively identify most precancerous lesions• Is noninvasive, easy to perform and inexpensive• Can be performed by all levels of healthcare workers in almost anysetting• Provides immediate results that can be used to inform decisions andactions regarding treatment• Requires supplies and equipment that are readily available locallyTREATMENTIn order for cervical cancer prevention programs to be truly effective andof public health value, testing should be linked to appropriate treatmentfor any precancerous lesions detected.What Lesions Needto Be Treated?There is clear consensus that high-grade (CIN II–III) lesions should betreated because they are more likely than low-grade lesions (CIN I) toprogress to cancer. Published studies indicate that most low-grade lesionswill regress spontaneously and thus do not require treatment. When closefollowup or histological confirmation is not feasible or possible,treatment of acetowhite lesions (which could be low-grade or high-grade1-10 Cervical Cancer Prevention Guidelines for Low-Resource Settings