Cervical Cancer Screening Using Papanicolaou Smear and Visual Inspection With Acetic Acid and Their Correlation With Colposcopy.

INTRODUCTION

Cervical cancer remains a leading cause of morbidity and mortality among women, particularly in low- and middle-income countries (LMICs), despite being largely preventable. In India, delayed diagnosis and limited access to screening contribute to late-stage presentation. This study evaluates the effectiveness of visual inspection with acetic acid (VIA) and Papanicolaou (Pap) smear, and their correlation with colposcopic findings.

METHODS

This prospective observational study was conducted over 18 months on 170 women aged 25-65 years. All participants underwent VIA and Pap smear screening. Those with abnormal findings underwent colposcopy and Swede scoring, and biopsies were taken based on a colposcopic Swede score ≥ 5. Histopathological examination (HPE) served as the gold standard for diagnosis. Statistical analysis included descriptive statistics and chi-squared testing. Diagnostic parameters, i.e., sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, were calculated. A p-value < 0.05 was considered statistically significant.

RESULTS

The mean age of participants was 40.15±8.99 years. The most common complaint was vaginal discharge in 155/170 (91.2%). VIA was positive in 56/170 (32.9%) participants, and Pap smear abnormalities were noted in 39/170 (22.9%). Among the 58 women who underwent colposcopy, cervical intraepithelial neoplasia (CIN) 1 was the most common lesion in 28/58 (48.3%), followed by chronic cervicitis in 17/58 (29.3%), and CIN 2 and CIN 3 in 5/58 (8.6%) each. Histopathology confirmed CIN 2 in 5/10 (50%), CIN 3 in 4/10 (40%), and squamous cell carcinoma (SCC) in 1/10 (10%) cases among the 10 biopsied patients. However, the histopathological validation is limited by the small number of biopsies (n=10), which was considered when interpreting diagnostic accuracy. Diagnostic performance showed that VIA had a sensitivity of 100%, specificity of 10%, PPV of 67.9%, and NPV of 100%, while Pap smear had a sensitivity of 94.7%, specificity of 85%, PPV of 92.3%, and NPV of 89.5%. Statistically significant associations were observed between VIA results and colposcopy findings (p<0.0001), Pap results and colposcopy findings (p<0.0001), and colposcopic and histopathological findings (p=0.007). The mean age at marriage of the study participants was 20.77±1.93 years. Significant associations were observed between abnormal VIA and Pap smear results with early age at marriage between 18 and 20 years (p=0.002 and p=0.008, respectively), lower socioeconomic status (p=0.001 and p=0.024, respectively), and high parity (p<0.0001 and p=0.002, respectively).

CONCLUSION

VIA and Pap smear serve as effective frontline screening tools, with Pap smear offering higher specificity. VIA's high sensitivity and ease of implementation make it suitable for mass screening in low-resource settings, while Pap smear provides greater diagnostic accuracy when infrastructure allows. Integrating VIA and Pap screening, followed by colposcopic confirmation, can improve early detection and reduce cervical cancer burden in LMICs. Adopting a tiered screening model, beginning with VIA at primary care levels and referring positive cases for Pap smear and colposcopy, could enhance early detection and optimize resource allocation in low-resource settings. Implementation of structured national screening programs alongside HPV vaccination is crucial to meet the WHO's 2030 cervical cancer elimination targets.