Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2010
Determinants of VIA (Visual Inspection of the Cervix After Acetic Acid Application) positivity in cervical cancer screening of women in a peri-urban area in Andhra Pradesh, India.
Сравнительное исследованиеСтатьяПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Vedantham Haripriya, Silver Michelle I, Kalpana B, Rekha C, Karuna B P, Vidyadhari K, Mrudula S, Ronnett Brigitte M, Vijayaraghavan K, Ramakrishna Gayatri, Sowjanya Pavani, Laxmi Shantha, Shah Keerti V, Gravitt Patti E, CATCH Study Team
Аннотация
OBJECTIVES: Visual inspection of the cervix after acetic acid application (VIA) is widely recommended as the method of choice in cervical cancer screening programs in resource-limited settings because of its simplicity and ability to link with immediate treatment. In testing the effectiveness of VIA, human papillomavirus DNA testing, and Pap cytology in a population-based study in a peri-urban area in Andhra Pradesh, India, we found the sensitivity of VIA for detection of cervical intraepithelial neoplasia grade 2 and worse (CIN2+) to be 26.3%, much lower than the 60% to 90% reported in the literature. We therefore investigated the determinants of VIA positivity in our study population.
METHODS: We evaluated VIA positivity by demographics and reproductive history, results of clinical examination, and results from the other screening methods.
RESULTS: Of the 19 women diagnosed with CIN2+, only 5 were positive by VIA (positive predictive value, 3.1%). In multivariate analysis, VIA positivity (12.74%) was associated with older age, positive Pap smear, visually apparent cervical inflammation, and interobserver variation. Cervical inflammation of unknown cause was present in 21.62% of women. In disease-negative women, cervical inflammation was associated with an increase in VIA positivity from 6.1% to 15.5% (P<0.001). Among the six gynecologists who performed VIA, the positivity rate varied from 4% to 31%.
CONCLUSIONS: The interpretation of VIA is subjective and its performance cannot be readily evaluated against objective standards.
IMPACT: VIA is not a robust screening test and we caution against its use as the primary screening test in resource-limited regions.
METHODS: We evaluated VIA positivity by demographics and reproductive history, results of clinical examination, and results from the other screening methods.
RESULTS: Of the 19 women diagnosed with CIN2+, only 5 were positive by VIA (positive predictive value, 3.1%). In multivariate analysis, VIA positivity (12.74%) was associated with older age, positive Pap smear, visually apparent cervical inflammation, and interobserver variation. Cervical inflammation of unknown cause was present in 21.62% of women. In disease-negative women, cervical inflammation was associated with an increase in VIA positivity from 6.1% to 15.5% (P<0.001). Among the six gynecologists who performed VIA, the positivity rate varied from 4% to 31%.
CONCLUSIONS: The interpretation of VIA is subjective and its performance cannot be readily evaluated against objective standards.
IMPACT: VIA is not a robust screening test and we caution against its use as the primary screening test in resource-limited regions.