Screening for Cervical Neoplasia in an Unselected Rural Guatemalan Population Using Direct Visual Inspection After Acetic Acid Application: A Pilot Study

Objective. To assess the acceptability of cervical screening using direct visual inspection after acetic acid application followed by immediate cryotherapy for cervical intraepithelial neoplasia among women in rural Guatemala. Materials and Methods. An unselected group of 1,052 women voluntarily registered to undergo cervical screening using direct visual inspection of the cervix after acetic acid application. Women with acetowhite changes consistent with cervical intraepithelial neoplasia were offered immediate cryotherapy. Results. Cervical screening was deferred in 80 (7.6%) registrants, and 18 (1.7%) refused to undergo an examination. Among the 954 registrants screened, 125 (13%) had findings consistent with cervical intraepithelial neoplasia. Cryotherapy was deferred in three patients. A total of 121 (99%) women agreed to immediate cryotherapy. Conclusion. Direct cervical visualization after acetic acid application followed by immediate cryotherapy for acetowhite changes consistent with cervical intraepithelial neoplasia would be a well-accepted method of cervical screening in rural Guatemala