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Article

Cervical Visual Inspection with Acetic Acid (VIA) and Oncogenic Human Papillomavirus Screening in Rural Indigenous Guatemalan Women: Time to Rethink VIA

1
Robert Stempel (RS) College of Public Health and Social Work, Florida International University (FIU), Miami, FL 33199, USA
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Partner for Surgery, McLean, VA 22101, USA
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Laboratory of Translational Genomics, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD 20850, USA
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Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
*
Author to whom correspondence should be addressed.
Academic Editors: Pamela Valera, Adana Llanos and Luis Alzate-Duque
Int. J. Environ. Res. Public Health 2021, 18(23), 12406; https://doi.org/10.3390/ijerph182312406
Received: 21 September 2021 / Revised: 16 November 2021 / Accepted: 20 November 2021 / Published: 25 November 2021
Single-visit “screen-and-treat” strategies using visual inspection with acetic acid (VIA) and cryotherapy (liquid nitrous oxide ablation) in low-resource settings are commonly used to detect and treat precancerous lesions for cervical cancer prevention. This study compared VIA sensitivity and specificity in rural indigenous Guatemalan communities, to that of oncogenic human papillomavirus (HPV) testing for detection of precancerous changes, using cytology as the reference standard. Between 3–8 September 2017, trained nurses examined 222 women aged 23–58 years with VIA. Specimens for liquid-based cytology and HPV testing were obtained prior to VIA with a cytobrush and transported in PreservCyt to a US clinical laboratory. VIA and HPV test sensitivities were assessed as proportions of women with abnormal cytology that had abnormal VIA or HPV results, respectively, and specificities, as proportions with normal cytology with normal VIA or negative HPV tests. Of 222 women, 18 (8.1%) had abnormal cytology (1 carcinoma in a participant who received VIA-based cryotherapy in 2015, 4 high- and 5 low-grade squamous intraepithelial lesions, and 8 atypical squamous cells of undetermined significance (ASCUS)). Excluding ASCUS, sensitivities of VIA and HPV were 20.0% and 100%, respectively. VIA-based screening may not be acceptable for detecting precancerous lesions, and field cryotherapy for preventing malignancy. The World Health Organization recommended in 2021 “…using HPV DNA detection as the primary screening test rather than VIA or cytology”. View Full-Text
Keywords: cervical cancer screening; visual inspection with acetic acid; human papillomavirus; cytology; cryotherapy; low-resource settings; low- and middle-income countries; Guatemala cervical cancer screening; visual inspection with acetic acid; human papillomavirus; cytology; cryotherapy; low-resource settings; low- and middle-income countries; Guatemala
MDPI and ACS Style

Jeffries, A.; Beck-Sagué, C.M.; Marroquin-Garcia, A.B.; Dean, M.; McCoy, V.; Cordova-Toma, D.A.; Fenkl, E.; Madhivanan, P. Cervical Visual Inspection with Acetic Acid (VIA) and Oncogenic Human Papillomavirus Screening in Rural Indigenous Guatemalan Women: Time to Rethink VIA. Int. J. Environ. Res. Public Health 2021, 18, 12406. https://doi.org/10.3390/ijerph182312406

AMA Style

Jeffries A, Beck-Sagué CM, Marroquin-Garcia AB, Dean M, McCoy V, Cordova-Toma DA, Fenkl E, Madhivanan P. Cervical Visual Inspection with Acetic Acid (VIA) and Oncogenic Human Papillomavirus Screening in Rural Indigenous Guatemalan Women: Time to Rethink VIA. International Journal of Environmental Research and Public Health. 2021; 18(23):12406. https://doi.org/10.3390/ijerph182312406

Chicago/Turabian Style

Jeffries, Anne, Consuelo M. Beck-Sagué, Ariel B. Marroquin-Garcia, Michael Dean, Virginia McCoy, Diego A. Cordova-Toma, Eric Fenkl, and Purnima Madhivanan. 2021. "Cervical Visual Inspection with Acetic Acid (VIA) and Oncogenic Human Papillomavirus Screening in Rural Indigenous Guatemalan Women: Time to Rethink VIA" International Journal of Environmental Research and Public Health 18, no. 23: 12406. https://doi.org/10.3390/ijerph182312406

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