Is visual inspection with acetic acid better than cervical cytology to screen women ≥ 40 years of age for carcinoma cervix? A cross-sectional study on proportion of screen-positive women (by VIA and cervical cytology) having CIN II/III lesion on cervical biopsy: difference between two age groups and among screening methods.

OBJECTIVE: Proportion of CIN II/III lesion on cervical biopsy among screen-positive women of age group < 40 years and ≥ 40 years undergoing screening for carcinoma cervix by Pap smear and visual inspection of cervix with acetic acid (VIA) was determined (both the tests were performed on same population). Difference in proportion of CIN II/III lesion among screen-positive women, between two age groups (for both methods) and between methods (for both age groups) was determined.

RESULT: In < 40 years age group, proportion of screen-positive women with CIN II/III lesion was similar for both cytology or VIA (12.95 vs. 9.8%). For ≥ 40 year age group, compared to cytology, VIA detected higher proportions of CIN II or III lesion (4.1 vs. 13.3%). Proportion of screen-positive women having CIN II/III lesion was higher in < 40 years compared to ≥ 40 year age group (12.95 vs. 4.1%) with cytology, while for VIA no difference was detected in between age groups (9.8 vs. 13.3%).

CONCLUSION: Cytological screening is less sensitive in women ≥ 40 years while VIA has a uniform sensitivity for both groups.