الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Cervical cancer is an important women’s reproductive health problem. It is a preventable disease of significant public health concern especially in developing countries. .
Globally, cervical cancer remains an important cause of mortality among young women, with an estimated 570,000 new cases in 2018 worldwide, most occurring in developing countries. In Egypt the incidence of cervical cancer is 969 per year and 631 die from the disease.
Unlike many cancers, cervical cancer can be prevented. This is because the cervix is easily accessible. This prevention can be achieved using relatively inexpensive technologies to detect abnormal cervical tissue before it progresses to invasive cervical cancer. Most developed countries like the United States saw dramatic reductions in the incidence and death rates from cervical cancer following the implementation of organized screening programmes. Accessibility to treatment, early detection, reduction in parity, and other risk factors have contributed to this decline.
Early detection is the best approach to reduce the burden of cervical cancers, thus, screening to identify pre-invasive lesions of this malignancy should be a top priority of global health. In spite of numerous studies on cervical cancer screening approaches in low-source settings, only a slight improvement has been made in developing countries. The inefficiency of screening approaches in these countries has led to undesirable rate of mortality from cancer of cervix.
The implementation of screening programs with cervical cytology smears (Pap smear) has led to a considerable reduction in the incidence of
Summary
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cervical cancer in developed countries. Despite advances in screening methods and the widespread use of these programs, this issue remains a major health problem for women in developing countries with limited resources. The main reason for this unbalanced load of cervical cancer in developing countries is the absence of well-organized screening programs.
Pap test, which is a cytological screening test, requires sufficient laboratory services, technical expertise for good quality smears, and regular monitoring in women with positive tests. Furthermore, previous meta-analyses of research studies indicated that Pap smear sensitivity is only 50%. These limitations of Pap test have led to the innovation of new alternative methods for screening.
The new screening methods should improve the limitations of conventional methods and specially be applicable in developing countries. The effectiveness of a screening program is reflected by optimization of false-negative and false-positive errors. Visual inspection after application of acetic acid and digital cervicography are some of these new strategies.
VIA is one of the adjunctive testing for cervical cancer based on histochemical reaction with better sensitivity than Pap smear, although its specificity is lower. In this method the cervix is directly observed by the health care provider after washing the cervix with acetic acid. Abnormal tissue such as that found in pre-cancerous or cancerous lesions will be affected by acetic acid and its color will change to white, whereas normal cervix will appear unaffected. The ranges of sensitivity and specificity of VIA in detecting cervical lesions have been reported as 70–85% and 67–85%, respectively.
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VIA as a low-cost alternative can provide immediate results and also stand treatment on diagnosis using a single visit approach which is appropriate for low-source settings where there is difficulty in tracing females with positive Pap test.
The main objective of this study was to compare sensitivity and specificity of VIA test and pap smear for detecting cervical neoplasia.
This was a comparative cross-sectional study was conducted at family planning clinic, Alexandria Governate, Egypt including 420 women. The duration of the study ranges from January 2019 to August 2020.
The main results of the study revealed that: The age of the studied patients ranged from 22 - 60 with mean± SD of 36.31 ± 10.44 years, meanwhile, mean BMI is 26.92 ± 3.65 kg/m2. The mean parity of patients was 3.16 ± 1.204, and mean gravidity was 4.08 ± 1.46. The most prevalent complain found among the patients was persistent vaginal discharge (51.2%) then pelvic pain (27.6%), intermenstrual bleeding (11.4%), postcoital bleeding (7.6%) and there were only 9 complain from post-menopausal bleeding. There were 90.2 % showed negative Pap smear. Although, there were 5.95% of the patients were ASC-US, 2.6% were LSIL and 1.2% were HSIL. Thus, in total 9.8 % of Pap smears were reported positive. 41 patients were positive Pap smear test with false positive was 53.7%. The Pap smear sensitivity was 52.78%, specificity was 94.27%, NPV was 95.51% and PPV was 46.34% with accuracy of 90.71% in relation to histopathological result of colposcopic positive cases.
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72 patients were positive VIA test with false positive was 56.95%. The VIA test sensitivity was 86.11%, specificity was 89.32%, NPV was 98.56% and PPV was 43.05% with accuracy of 89.05% in relation to histopathological result of colposcopic positive cases.
Based on our findings, we recommend for further studies on large geographical scale and on larger sample size to emphasize our conclusion.