Evaluation of human-papillomavirus testing and visual inspection for cervical cancer screening in Rwanda

M. Chantal Umulisa, Silvia Franceschi, Iacopo Baussano, Vanessa Tenet, Mathilde Uwimbabazi, Belson Rugwizangoga, Daniëlle A.M. Heideman, Anne M. Uyterlinde, Teresa M. Darragh, Peter J.F. Snijders, Felix Sayinzoga, Gary M. Clifford

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: A pilot screening campaign in Rwanda, based on careHPV-testing followed by visual inspection with acetic acid triage (careHPV+VIA triage), was evaluated against other WHO-recommended screening options, namely HPV screen-and-treat and VIA screen-and-treat. Methods: 764 women aged 30-69 underwent at visit 1: i) VIA, and cervical cell collection for ii) careHPV in Rwanda, and iii) liquid-based cytology and GP5+/6+HR-HPV PCR in The Netherlands. All 177 women positive by VIA, careHPV and/or PCR were recalled, of whom 84% attended. At visit 2, VIA was again used to triage screen-positive women for treatment and to obtain biopsies from all women either from visible lesions or at 12 o'clock of the squamocolumnar junction. Cross-sectional screening indices were estimated primarily against histological high-grade squamous intraepithelial lesions or worse (hHSIL+), after imputation of missing histology data, based on 1-visit or 2-visit approaches. Results: In a 1-visit screen-and-treat approach, VIA had sensitivity and specificity of 41% and 96%, respectively, versus 71% and 88% for careHPV, and 88% and 86% for PCR. In a 2-visit approach (in which hHSIL+ imputed among women without visit 2 were considered untreated) careHPV sensitivity dropped to 59% due to loss of 13% of hHSIL+. For careHPV+VIA triage, sensitivity dropped further to 35%, as another 24% of hHSIL+ were triaged to no treatment. Conclusions: CareHPV was not as sensitive as gold-standard PCR, but detected considerably more hHSIL+ than VIA. However, due to careHPV-positive hHSIL+ women being lost to follow-up and/or triaged to no treatment, 2-visit careHPV+VIA triage did not perform better than VIA screen-and-treat.

Original languageEnglish
Article number59
JournalBMC Women's Health
Volume18
Issue number1
DOIs
Publication statusPublished - Apr 24 2018

Fingerprint

Rwanda
Early Detection of Cancer
Uterine Cervical Neoplasms
Triage
Polymerase Chain Reaction
Human papillomavirus 6
Lost to Follow-Up
Acetic Acid
Gold
Netherlands
Cell Biology
Histology
Therapeutics
Biopsy
Sensitivity and Specificity

Keywords

  • Cervical cancer
  • Human papillomavirus
  • Rwanda
  • Screening
  • Visual inspection

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

Cite this

Umulisa, M. C., Franceschi, S., Baussano, I., Tenet, V., Uwimbabazi, M., Rugwizangoga, B., ... Clifford, G. M. (2018). Evaluation of human-papillomavirus testing and visual inspection for cervical cancer screening in Rwanda. BMC Women's Health, 18(1), [59]. https://doi.org/10.1186/s12905-018-0549-5

Evaluation of human-papillomavirus testing and visual inspection for cervical cancer screening in Rwanda. / Umulisa, M. Chantal; Franceschi, Silvia; Baussano, Iacopo; Tenet, Vanessa; Uwimbabazi, Mathilde; Rugwizangoga, Belson; Heideman, Daniëlle A.M.; Uyterlinde, Anne M.; Darragh, Teresa M.; Snijders, Peter J.F.; Sayinzoga, Felix; Clifford, Gary M.

In: BMC Women's Health, Vol. 18, No. 1, 59, 24.04.2018.

Research output: Contribution to journalArticle

Umulisa, MC, Franceschi, S, Baussano, I, Tenet, V, Uwimbabazi, M, Rugwizangoga, B, Heideman, DAM, Uyterlinde, AM, Darragh, TM, Snijders, PJF, Sayinzoga, F & Clifford, GM 2018, 'Evaluation of human-papillomavirus testing and visual inspection for cervical cancer screening in Rwanda', BMC Women's Health, vol. 18, no. 1, 59. https://doi.org/10.1186/s12905-018-0549-5
Umulisa, M. Chantal ; Franceschi, Silvia ; Baussano, Iacopo ; Tenet, Vanessa ; Uwimbabazi, Mathilde ; Rugwizangoga, Belson ; Heideman, Daniëlle A.M. ; Uyterlinde, Anne M. ; Darragh, Teresa M. ; Snijders, Peter J.F. ; Sayinzoga, Felix ; Clifford, Gary M. / Evaluation of human-papillomavirus testing and visual inspection for cervical cancer screening in Rwanda. In: BMC Women's Health. 2018 ; Vol. 18, No. 1.
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AU - Franceschi, Silvia

AU - Baussano, Iacopo

AU - Tenet, Vanessa

AU - Uwimbabazi, Mathilde

AU - Rugwizangoga, Belson

AU - Heideman, Daniëlle A.M.

AU - Uyterlinde, Anne M.

AU - Darragh, Teresa M.

AU - Snijders, Peter J.F.

AU - Sayinzoga, Felix

AU - Clifford, Gary M.

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N2 - Background: A pilot screening campaign in Rwanda, based on careHPV-testing followed by visual inspection with acetic acid triage (careHPV+VIA triage), was evaluated against other WHO-recommended screening options, namely HPV screen-and-treat and VIA screen-and-treat. Methods: 764 women aged 30-69 underwent at visit 1: i) VIA, and cervical cell collection for ii) careHPV in Rwanda, and iii) liquid-based cytology and GP5+/6+HR-HPV PCR in The Netherlands. All 177 women positive by VIA, careHPV and/or PCR were recalled, of whom 84% attended. At visit 2, VIA was again used to triage screen-positive women for treatment and to obtain biopsies from all women either from visible lesions or at 12 o'clock of the squamocolumnar junction. Cross-sectional screening indices were estimated primarily against histological high-grade squamous intraepithelial lesions or worse (hHSIL+), after imputation of missing histology data, based on 1-visit or 2-visit approaches. Results: In a 1-visit screen-and-treat approach, VIA had sensitivity and specificity of 41% and 96%, respectively, versus 71% and 88% for careHPV, and 88% and 86% for PCR. In a 2-visit approach (in which hHSIL+ imputed among women without visit 2 were considered untreated) careHPV sensitivity dropped to 59% due to loss of 13% of hHSIL+. For careHPV+VIA triage, sensitivity dropped further to 35%, as another 24% of hHSIL+ were triaged to no treatment. Conclusions: CareHPV was not as sensitive as gold-standard PCR, but detected considerably more hHSIL+ than VIA. However, due to careHPV-positive hHSIL+ women being lost to follow-up and/or triaged to no treatment, 2-visit careHPV+VIA triage did not perform better than VIA screen-and-treat.

AB - Background: A pilot screening campaign in Rwanda, based on careHPV-testing followed by visual inspection with acetic acid triage (careHPV+VIA triage), was evaluated against other WHO-recommended screening options, namely HPV screen-and-treat and VIA screen-and-treat. Methods: 764 women aged 30-69 underwent at visit 1: i) VIA, and cervical cell collection for ii) careHPV in Rwanda, and iii) liquid-based cytology and GP5+/6+HR-HPV PCR in The Netherlands. All 177 women positive by VIA, careHPV and/or PCR were recalled, of whom 84% attended. At visit 2, VIA was again used to triage screen-positive women for treatment and to obtain biopsies from all women either from visible lesions or at 12 o'clock of the squamocolumnar junction. Cross-sectional screening indices were estimated primarily against histological high-grade squamous intraepithelial lesions or worse (hHSIL+), after imputation of missing histology data, based on 1-visit or 2-visit approaches. Results: In a 1-visit screen-and-treat approach, VIA had sensitivity and specificity of 41% and 96%, respectively, versus 71% and 88% for careHPV, and 88% and 86% for PCR. In a 2-visit approach (in which hHSIL+ imputed among women without visit 2 were considered untreated) careHPV sensitivity dropped to 59% due to loss of 13% of hHSIL+. For careHPV+VIA triage, sensitivity dropped further to 35%, as another 24% of hHSIL+ were triaged to no treatment. Conclusions: CareHPV was not as sensitive as gold-standard PCR, but detected considerably more hHSIL+ than VIA. However, due to careHPV-positive hHSIL+ women being lost to follow-up and/or triaged to no treatment, 2-visit careHPV+VIA triage did not perform better than VIA screen-and-treat.

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KW - Human papillomavirus

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KW - Screening

KW - Visual inspection

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