Visual infection of the cerviz as a primary means of cervial cancer screening: results of a pilot study

OBJECTIVE: To measure the effectiveness of unaided visual inspection (UVI) of the cervix as a primary means of cervical cancer screening. DESIGN: A cross sectional study. SETTING: Five primary health care clinics in Mashonaland Province, Zimbabwe. SUBJECTS: 1,000 women aged between 25 and 55 years. MAIN OUTCOME MEASURES: Sensitivity and specificity of UVI. METHODS: 1,000 women attending primary health care clinics were screened for cervical cancer by six qualified nurses. An unlubricated bivalve speculum was inserted into the vagina under good light to visualize the cervix and a cervical cytology specimen was obtained followed by visual inspection of the cervix stained by 4% acetic acid. All women found to have abnormal cervices by visual inspection and/or by cervical cytology report were scheduled for colposcopy examination at Harare Central Hospital. RESULTS: 236 (23.6%) women had an abnormal cervical appearance after application with 4% acetic acid, out of which 157 (15.7%) were reported abnormal by cytology. True disease as defined by positive colposcopy and positive cytology was confirmed in 38 (3.8%) women. The sensitivity of UVI using colposcopy and cytology as a reference standard was 68.4%, specificity was 3.4%. CONCLUSION: The results of this study suggest that naked eye inspection of the cervix after application of acetic acid is a practical alternative to cervical cytology in screening for cervical cancer in countries with few resources like Zimbabwe.