Visual techniques for cervical cancer screening in Colombia

Introduction: Direct visual inspection for cervical cancer screening remains controversial whereas colposcopy-biopsy is considered the gold standard for diagnostic of preneoplastic cervical lesions. Objectives: To determine CIN2+ detection and false positive rates for colposcopy and direct visual inspection. Materials and methods: Women aged 25-59 underwent direct visual inspection with acetic acid (VIA) and lugol iodine (VIA-VILI), and colposcopy. Punch biopsies were obtained for any positive test. Using histology as the gold standard, detection rates and false-positive rates were compared for VIA, VIA-VILI, and colposcopy. Sensitivity and false-positive ratios with corresponding 95% confidence intervals were estimated. Results: 5,011 women were included and 602 biopsies obtained. Positivity rates for colposcopy high-grade and low-grade thresholds were 1.6% and 10.8%. Positivity rates for VIA and VIA-VILI were 7.4% and 9.9%. VIA showed significantly lower detection rate than colposcopy low grade threshold (SR 0.72, CI95% 0.57-0.91), and significantly lower false positive rate (FPR 0.70, CI95% 0.65-0.76). No significant differences between VIA-VILI and colposcopy low-grade threshold were observed. VIA and VIA-VILI showed significantly higher detection rates and false positive rates than colposcopy high-grade threshold. Sensitivity rates for visual inspection decreased with age and false positive rates increased. For all age groups false positive rates for VIA and VIA-VILI were significantly higher than colposcopy. Conclusions: Detection rates for VIA-VILI similar to colposcopy low-grade threshold represent a chance for reducing cervical cancer mortality through see and-treat approaches among women with limited access to health care. Lower detection rates suggest reviewing high-grade colposcopic findings as the threshold for biopsy in certain settings.