In Ethiopia, 29 million women over 14 years of age are at risk of developing cervical cancer . In the year 2018, 6,294 women diagnosed as new cervical cancer cases and 4,884 women died from the disease .
Even though the burden of the cervical cancer in Ethiopia is immense, the national cancer screening program is solely based on VIA which has high variability in test results due to examiners’ judgment . Our study shares the results of the first cervical cancer screening in Ethiopia using LBC. In our study, the prevalence of abnormal squamous intraepithelial lesion was 114 (27%), which is higher than the 17% reported in China . Prevalence of LSIL and HSIL were 23.2%) and 4.1 %,) in our study respectively, which are much higher than the 1.9% and 0.6% prevalence in Sao Paulo, respectively .
Another study in India reported lower LSIL prevalence (7.5%) and higher HSIL prevalence (10.5%) than our study . Much lower prevalence of LSIL and HSIL (2%) has been reported elsewhere . These variations in the prevalence of intraepithelial lesions may be due to differences in the availability of the HPV vaccines , the presence of organized cervical cancer screening , and socio-economic variability across locations .
In our study, higher proportion of older women (ages 35-65) and those women whose SCJ was not visible during examination tested positive on LBC screening test, the latter of which is practically impossible to observe with VIA. Logistic regression analysis showed women aged 35-65 years were 2.4 times more likely to have abnormal intraepithelial lesion compared to women aged 21-34. These told, LBC screening was better at detecting advanced cervical lesions (HSIL) and cervical lesions in relatively older ages which is not true for VIA screening .
VIA detected 18 (6.1%) cases of cervical lesions, which is similar to the 5% reported in West Shewa, Ethiopia , but much lower than the 14.7%  and 11.4%  reported in Rwanda and China, respectively. Among women who were tested using both LBC and VIA, a high proportion (83.3%) that tested positive with LBC, tested negative on the VIA test, meaning VIA screening missed a considerable proportion of women with abnormal cervical lesions. This finding is similar to a study in China that showed VIA missed the majority of CIN2+ in older women and was less sensitive than LBC . As our study showed, there was no agreement between LBC and VIA screening tests and the variability was statistically significant (kappa =0.155, P=0.006).
Organized cytology-based screening is the most efficient screening method for the detection of cervical lesions and has resulted in significant reduction in cervical cancer in developed countries . However, financial constraints and technical challenges in implementing cytology-based screening has made VIA the preferred approach in low and middle incomes countries . Though VIA screening missed most cervical lesions, its low cost, ease of use and lack of need for equipment, and immediate availability of results, offers many advantages in developing countries .
In conclusion cytology has detected high proportion of cervical lesions and using LBC where resources and facilities allow would increase case detection rates.