SynthesisBMJ (Clinical research ed.)2015
Performance of alternative strategies for primary cervical cancer screening in sub-Saharan Africa: systematic review and meta-analysis of diagnostic test accuracy studies.
Synthesis in BMJ (Clinical research ed.), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
62 citing papers in PubMed, 6 syntheses or guidelines pooled it, 138 citations in OpenAlex.
- Distribution of high- and low-risk human papillomavirus genotypes and their prophylactic vaccination coverage among West African women: systematic review.Journal of the Egyptian National Cancer Institute · 2023Pooled it
- Pooled it
- Comparative accuracy of cervical cancer screening strategies in healthy asymptomatic women: a systematic review and network meta-analysis.Scientific reports · 2022Pooled it
- Diagnostic accuracy of anthropometric indices for discriminating elevated blood pressure in pediatric population: a systematic review and a meta-analysis.BMC pediatrics · 2022Pooled it
- Accuracy of Smartphone Images of the Cervix After Acetic Acid Application for Diagnosing Cervical Intraepithelial Neoplasia Grade 2 or Greater in Women With Positive Cervical Screening: A Systematic Review and Meta-Analysis.JCO global oncology · 2021Pooled it
- Cervical cancer screening decentralized policy adaptation: an African rural-context-specific systematic literature review.Global health action · 2019Pooled it
- Effectiveness of Clinic-Based Patient-Led Human Papillomavirus DNA Self-Sampling among HIV-Infected Women in Uganda.International journal of environmental research and public health · 2023Trial
- Diagnostic accuracy of an artificial intelligence-driven cytopathological tool in detecting cervical pre-cancerous lesions from Pap smear images.Frontiers in digital health · 2026Article
- Distribution of High-Risk Human Papillomavirus in Self-Collected Cervicalvaginal Samples from the General Malian Population.Biochemical genetics · 2025Article
- AI supported diagnostic innovations for impact in global women's health.BMJ (Clinical research ed.) · 2025Article
- The High Prevalence of Oncogenic HPV Genotypes Targeted by the Nonavalent HPV Vaccine in HIV-Infected Women Urgently Reinforces the Need for Prophylactic Vaccination in Key Female Populations Living in Gabon.Diseases (Basel, Switzerland) · 2025Article
- To determine the diagnostic accuracy of visual inspection of cervix with acetic acid as a screening tool to detect preinvasive cervical cancer - A meta-analysis.Journal of family medicine and primary care · 2025Review
- Genotype distribution of human papillomavirus among women with cervical cancer stratified by HIV status in Tanzania.PloS one · 2025Article
- Utility of colposcopy for the screening and management of cervical cancer in Africa: a cross-sectional analysis of providers' training and practices.BMC health services research · 2024Article
- Genome-integrated Human Papilloma Viruses Testing: A Complement to Colposcopy-guided Biopsy for Cervical Cancer Screening.Current medical science · 2024Article
- Comparative effectiveness of implementation strategies for Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services (ACCESS study): protocol for a cluster randomized hybrid type III trial in Nigeria.Implementation science : IS · 2024Article
- Cervical Squamous Cell Carcinoma Diagnosis by FTIR Microspectroscopy.Molecules (Basel, Switzerland) · 2024Article
- Implementation of cervical cancer prevention and screening across five tertiary hospitals in Nepal and its policy implications: A mixed-methods study.PLOS global public health · 2024Article
- Article
- Detection of cervical precancerous lesions and cancer by small-scale RT-qPCR analysis of oppositely deregulated mRNAs pairs in cytological smears.Frontiers in oncology · 2024Article
2 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess and compare the accuracy of visual inspection with acetic acid (VIA), visual inspection with Lugol's iodine (VILI), and human papillomavirus (HPV) testing as alternative standalone methods for primary cervical cancer screening in sub-Saharan Africa.
designSystematic review and meta-analysis of diagnostic test accuracy studies. DATA SOURCES: Systematic searches of multiple databases including Medline, Embase, and Scopus for studies published between January 1994 and June 2014. REVIEW
methodsInclusion criteria for studies were: alternative methods to cytology used as a standalone test for primary screening; study population not at particular risk of cervical cancer (excluding studies focusing on HIV positive women or women with gynaecological symptoms); women screened by nurses; reference test (colposcopy and directed biopsies) performed at least in women with positive screening results. Two reviewers independently screened studies for eligibility and extracted data for inclusion, and evaluated study quality using the quality assessment of diagnostic accuracy studies 2 (QUADAS-2) checklist. Primary outcomes were absolute accuracy measures (sensitivity and specificity) of screening tests to detect cervical intraepithelial neoplasia grade 2 or worse (CIN2+).
results15 studies of moderate quality were included (n=61,381 for VIA, n=46,435 for VILI, n=11,322 for HPV testing). Prevalence of CIN2+ did not vary by screening test and ranged from 2.3% (95% confidence interval 1.5% to 3.3%) in VILI studies to 4.9% (2.7% to 7.8%) in HPV testing studies. Positivity rates of VILI, VIA, and HPV testing were 16.5% (9.8% to 24.7%), 16.8% (11.0% to 23.6%), and 25.8% (17.4% to 35.3%), respectively. Pooled sensitivity was higher for VILI (95.1%; 90.1% to 97.7%) than VIA (82.4%; 76.3% to 87.3%) in studies where the reference test was performed in all women (P<0.001). Pooled specificity of VILI and VIA were similar (87.2% (78.1% to 92.8%) v 87.4% (77.1% to 93.4%); P=0.85). Pooled sensitivity and specificity were similar for HPV testing versus VIA (both P ≥ 0.23) and versus VILI (both P ≥ 0.16). Accuracy of VIA and VILI increased with sample size and time period.
conclusionsFor primary screening of cervical cancer in sub-Saharan Africa, VILI is a simple and affordable alternative to cytology that demonstrates higher sensitivity than VIA. Implementation studies are needed to assess the effect of these screening strategies on the incidence and outcomes of cervical cancer in the region.
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