CERVICAL CANCER SCREENING IN LAGOS:COMPARISON OF THE DETECTION RATE OF ABNORMALITIES USING CONVENTIONAL CYTOLOGY,LIQUID- BASED CYTOLOGY,VISUAL INSPECTION WITH ACETIC ACID AND HPV DNA TESTING. A PROSPECTIVE STUDY

Abstract

Background: Cervical cancer is the leading gynaecological cause of morbidity and mortality
amongst women worldwide with more than half a million new cases diagnosed yearly.
Screening for premalignant lesions has achieved substantial reduction in its incidence in
developed countries. Organizing a screening programme in a developing country such as
Nigeria has been fraught with setbacks due to lack of both infrastructure and technical
manpower and this has been a major drawback in reducing the incidence of cervical cancer
Objective: This study set out to compare conventional cytology with liquid –based cytology
(LBC),visual inspection with acetic acid (VIA) and HPVDNA testing in the screening of
cervical cancer.
Materials and Methods: One hundred women attending the family planning clinic at Igando
General Hospital, Lagos State were screened using conventional cytology with liquid-based
cytology, visual inspection with acetic acid and HPV DNA testing. Demographic data of the
participants were collected and samples taken after obtaining their consent. For this study
patients having ASCUS and above were considered positive.
Result: All the 100 subjects participated fully in all the four cervical cancer screening methods
giving a participation rate of 100%.Their ages ranged from 30 to 60years with a mean age of
40years (SD+_8.07). Majority (95%) were married in a monogamous family setting and 99%
had at least primary school education. Eighty nine percent attained menarche at age above
13years while 93% attained sexual debut after the age of sixteen years Eighty two percent had
less than 5 lifetime partners. Abnormal findings were highest for LBC 8%, this was closely
followed by conventional cytology 7%, HPVDNA 6% and VIA with a proportion of 5% . HPV
was positive for hrHPV in 6% of case consisting of seven high risk strains. Although 26
participants with abnormal findings on any of the tests were referred for follow up with
colposcopic examination and biopsy, only three of them agreed to and underwent
colposcopy-directed cervical biopsy.
One had CIN III while the remaining two were normal on histology.
Conclusion: There is no significant difference in the proportion of the participants testing
positive with any of the screening tests. However more positive cases were identified on
cytology and if combined with HPV DNA testing fewer no of patients will require follow up
with colposcopy and biopsy. The greatest drawback to this study is the fact that women were
not enlightened enough to appreciate the importance of follow up of abnormal test results. It
would have been possible to further validate the methods .It is hoped that this study will serve
as a baseline for a larger population –based study in future.

CERVICAL CANCER SCREENING IN LAGOS:COMPARISON OF THE DETECTION RATE OF ABNORMALITIES USING CONVENTIONAL CYTOLOGY,LIQUID- BASED CYTOLOGY,VISUAL INSPECTION WITH ACETIC ACID AND HPV DNA TESTING. A PROSPECTIVE STUDY