TESTING CERVICOGRAPHY AND CERVICOSCOPY AS SCREENING-TESTS FOR CERVICAL-CANCER

Aims and Background. Suboptimal sensitivity is currently reported for Pap test in screening for cervical cancer. Colposcopy is known to be m ore sensitive than cytology but its use as a screening test Is not pos sible due to costs and complexity. Screening by cervicography has been suggested as a compromise being less costly and feasible. The present study evaluates the feasibility of screening by cervicography and cer vicoscopy (naked eye examination of the cervix after acetic acid lavag e) on a consecutive screening series. Methods: Cervicography and cervi coscopy were performed by the smear taker in subjects consecutively at tending a screening clinic. Women with abnormal cytology (atypia or mo re severe lesion) and/or abnormal cervicography or cervicoscopy (aceto white lesion) underwent colposcopic assessment. The three screening me thods were compared according to positivity rate, CIN 2-3 detection ra te and positive predictive value. Results: 2105 consecutive subjects w ere screened. Positivity rate was 3.8 %, 15.3 % or 25.4 % for cytology , cervicography or cervicoscopy, respectively, 486 of 555 women attend ed the assessment phase, 281 directed biopsies were performed and 8 CI N 2-3 lesions were detected. Cytology, cervicography and cervicoscopy, detected 5.5, or 7 of 8 CIN 2-3 lesions, respectively. The positive p redictive value was 0 % for cytologic atypia, 25 % for cytologic SIL, 1.75 % for cervicography and 2.05 % for cervicoscopy. Detecting one CI N 2-3 lesion at cytology cost $ 5,543. The cost per each additional cy tologically negative CIN 2-3 lesion detected at cervicography or cervi coscopy was $ 12,947 or $ 3,916, respectively. Conclusions: The study confirms the limited sensitivity of cytology for CIN 2-3. The associat ion of cervicography was not cost effective. Cervicoscopy was poorly s pecific but increased the detection rate of CIN 2-3 at relatively low costs. Cervicoscopy is worth further evaluation as a screening test.