Efficacy of Pap Smear versus VIA for detecting HPV-related Cervical Cancer in sexually active women in Adamawa and Taraba States: A Comparative Study

Human Papillomavirus (HPV) is recognized as the most prevalent sexually transmitted viral infection among sexually active adolescents. This study aimed to assess the efficacy of Pap smear versus Visual Inspection with Acetic Acid (VIA) in detecting HPV-related cervical cancer in sexually active women from Adamawa and Taraba States, Nigeria. The research involved 432 women, and the results revealed significant findings in the comparison between Pap smear and VIA. The prevalence rates of cytological abnormalities, precancerous lesions, and diagnostic accuracy indicators are presented, providing insights into the performance of each screening method. 432 of the women screened, 170 tested positive for precancerous lesions using VIA/VILI, resulting in a prevalence rate of 39.4%. Taraba State had the highest proportion of positive cases (96) with an incidence of 56.5%, while Adamawa State had 74 positive cases with a prevalence of 43.5%. The prevalence rates were statistically significant in Taraba State (OR = 1.281, df=1, 95% CL = 0.860-1.923, and P=0.027). For cervical cytological abnormalities detected by Papanicolaou smear, 195 (45.1%) of the women in both states were positive for abnormal cytology, while 236 (54.6%) were negative (showed no cervical abnormality). Most participants were diagnosed with low-grade squamous intraepithelial lesion (LSIL), accounting for 93 (21.6%). The proportion of atypical squamous cells of undetermined significance (ASCUS) was 61 (14.1%), and high-grade squamous intraepithelial lesion (HSIL) was 45 (10.4%). The participants' age ranged from 15 to 54 years, with the peak age prevalence observed in the 35-44 years’ group (48.8%) showing precancerous lesions, followed by the 25-34 years’ group with 50 cases (29. 4%).VIA confirmed a sensitivity of 61.76% (54.0-69.195% CL) and specificity of 65.27% (59.2-71.059% CL) with a positive predictive value (PPV), negative predictive value (NPV), and odds ratio (OR) of 53.6 (95% CL=10.0-15.0), 72.5 (95% CL=50.2-78.2), and 2.90, respectively. Cytological sensitivity, specificity, PPV, NPV, and OR were 53.6 (95% CL=46.7-51.2), 59.7 (95% CL=55.4-61.0), 53.5 (95% CL=49.4-58.2), 83.9 (95% CL=50.2-78.2), and 3.95. Cytological abnormality by Pap smear screening shows a moderate level of diagnostic performance over VIA, as the odds ratio for Pap smear is 3.95. However, VIA showed a statistically significant difference at P<.001. The study concludes that both VIA and Pap smear are valuable in detecting HPV-related cervical lesions, with Pap smear demonstrating higher sensitivity and specificity. These findings emphasize the importance of targeted prevention strategies, including vaccination programs, to control HPV infections and reduce cervical cancer prevalence.