Original researchCervical cancer screening by simple visual inspection after acetic acid☆
Section snippets
Materials and methods
The human subject review boards of both the Cleveland Clinic Foundation and the Cancer Institute/Hospital of the Chinese Academy of Medical Sciences approved the study. Acetic acid (5%) was applied to the cervix and, after waiting 1 minute, the cervix was inspected using a single 100-watt tungsten bulb in a goose-neck style light. A normal cervix had no white lesions. A diagnosis of low-grade cervical intraepithelial neoplasia (CIN) showed pale white lesions that might or might not abut the
Results
Among 1997 women screened, 43 had biopsy-proven CIN II, 31 had CIN III, and 12 had invasive cancer. Thirty-nine women had biopsies with at least CIN II in one quadrant, 18 had at least CIN II in two quadrants, 10 had at least CIN II in three, and 17 had at least CIN II in four quadrants, and two had no ectocervical lesion (they had only ECC positive for CIN II and CIN III). Visual inspection was done on all 1997 women in the study. The visual inspection results were normal in 1445 women (72%),
Discussion
Early efforts at nonmagnified visual diagnosis of cervical cancer did not use acetic acid. The technique was not specific enough to be practical, especially if a see-and-treat algorithm were to be considered. In addition, the focus was on downstaging cancers at detection rather than the detection of preinvasive disease.6, 7, 15 The practical aspect of dealing with the complexities of treating cancers as opposed to preinvasive disease led to efforts that would be more sensitive to detect
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Supported by Taussig Cancer Center Cleveland Clinic Foundation, Cleveland, Ohio; Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing, China; Terry Fox Foundation, Burnaby, British Columbia; Transamerica Corporation, San Francisco, California; Digene Corporation, Gaithersburg, Maryland; Cytyc Corporation, Boxborough, Massachusetts; Optical Biopsy Tech, LLC., Knoxville, Tennessee; and Carl Zeiss Inc., Thornwood, New York.