Background: Strategies to decrease the burden of cervical cancer in developed countries are often difficult to implement in low resource settings, which has stimulated researchers and others to search for novel approaches for screening. Colposcopy offers some advantages that might make it a reasonable strategy as a standalone screen and treat protocol in communities where the incidence of disease is high. To date, results for the screening accuracy of colposcopy as a screening tool have varied widely from low to high sensitivity and specificity in different studies. Methods: In this study, I analyzed cross sectional data from the medical records of 2,094 self referred women in a community cervical screening program in Haiti. The patients included in the final analyses received some combination of Pap smear, colposcopy and/or cervical biopsy, which allowed me to compare these techniques. The final study populations included 198 women who had both Pap smear and cervical biopsy, and 221 patients who had both colposcopy and cervical biopsy. The main outcome measure (cancer and precancer diagnoses) were operationalized as mild dysplasia or worse lesions on cervical biopsy. Diagnostic accuracy was determined by calculating the sensitivity, specificity, positive predictive values, and negative predictive values with 95% confidence intervals using cervical biopsy as the gold standard. Results: The prevalence of dysplasia or cancer on biopsy for the study populations was 41.9%-48.0%% while prevalence detected by Pap was 30.8%. Prevalence in the study populations detected by colposcopy was 66.7%-70.1%. Pap smear had a sensitivity of 68.7% (CI 57.6-78.4) and specificity was 96.5% (CI 91.0-99.0) using biopsy as the gold standard. The sensitivity for colposcopy was 96.2% (CI 91.0-99.0) compared to biopsy, and a specificity of Sp 53.9% (CI 44.0-63.0). Conclusion: Colposcopy identifies a population that includes most ofthe dysplasia at a price of including many false positives, placing the screened population at a significant risk of over treatment. Therefore, colposcopy is a reasonable screening strategy if the disease prevalence is high in the population of interest and the co-morbidity from over treatment is low.Master of Public Healt
