Performance of alternative strategies for primary cervical cancer screening in sub-Saharan Africa: systematic review and meta-analysis of diagnostic test accuracy studies.
Bottom Line: Inclusion criteria for studies were: alternative methods to cytology used as a standalone test for primary screening; study population not at particular risk of cervical cancer (excluding studies focusing on HIV positive women or women with gynaecological symptoms); women screened by nurses; reference test (colposcopy and directed biopsies) performed at least in women with positive screening results.Prevalence of CIN2+ did not vary by screening test and ranged from 2.3% (95% confidence interval 1.5% to 3.3%) in VILI studies to 4.9% (2.7% to 7.8%) in HPV testing studies.Implementation studies are needed to assess the effect of these screening strategies on the incidence and outcomes of cervical cancer in the region.
Affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, 1211 Geneva 14, Switzerland firstname.lastname@example.org.Show MeSH
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Mentions: We could not perform pooled analysis of predictive values of screening tests, because they are closely related to the disease prevalence. However, we used the pooled prevalence of disease obtained among studies to estimate the post-test probability of having CIN2+ or being free of disease by geographical area (fig 4, web appendix 8). The pooled positive predictive value was lower than 35% for any screening tests wherever the geographical area, suggesting that combining tests might improve the effectiveness of screening programmes. In such situations, the second test can be either an adjunct to the first, or used to select women among those who screened positive to the first test and who are at higher risk for cervical cancer and might need immediate care. Although VILI has been proposed as an adjunctive test to VIA,13 results from primary studies are controversial. A study in Colombia found that the combination of VIA and VILI performed better than VIA alone,52 whereas a recent study in Kenya found no difference.53
Affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, 1211 Geneva 14, Switzerland email@example.com.