Risk factors for cervical dysplasia in Kerala, India.

A study in Kerala, India, confirmed the importance of genital hygiene in the fight against infections that have a role in the development of cervical dysplasia and cancer. Many women cannot afford sanitary pads, while adequate facilities for washing after coitus are often unavailable. Health education, satisfactory living standards, and the empowerment of women are prerequisites for reducing the incidence of cervical dysplasia.

PIP: In India, cancer of the uterine cervix is the most often seen cancer in women. There are no organized community-based screening programs, mainly because of a lack of resources and a low level of awareness in the population. Findings are presented from a 2-year study in Kerala, India, of the role of genital hygiene and other sexual and reproductive risk factors in cervical dysplasia. 3450 female outpatients of mean age 39.5 years attending the Women and Children's Hospital, Thycaud, Trivandrum, were interviewed, of whom all but 15 were married. 68% of women under age 50 years had been sterilized postpartum, while 2.3%, 0.3%, and 1.8% of women used barrier contraception, oral contraception, and IUDs, respectively. The husbands of 2.3% of the women had undergone vasectomy and no contraception was used by 26% of the women. 33% of the women presented with vaginal discharge, the most common presenting symptom, and lower back pain was experienced by 16%. 70% reported always washing themselves after coitus, but only 8% reported using sanitary pads during menstruation. 93% of women who used sanitary pads had been educated in high schools or colleges. Inflammation was evident in 70% of smears overall; more than 80% of younger women and around 50% of older women. The age-specific prevalences of cytological abnormalities are shown, while regression analysis found increasing age, increasing parity, illiteracy, and poor sexual hygiene to be risk factors for cervical dysplasia. The low level of barrier contraception means that there is little chance of preventing STDs through the use of such methods, and genital tract infection was undoubtedly exacerbated by poor sexual hygiene.

Visual inspection of the uterine cervix after the application of acetic acid in the detection of cervical carcinoma and its precursors.

BACKGROUND: Organized cervical cytology screening programs are not feasible in many developing countries where cervical carcinoma is an important cause of mortality among adult women. This study compared visual inspection of the cervix after application of 3-4% acetic acid (VIA, or cervicoscopy) with cytology as methods for the detection of cervical carcinoma and its precursors. METHODS: Three thousand women were examined by both VIA and cytology. Those positive on one or both of the screening tests (n = 423) or those who had clinically suspicious lesions even if the tests were negative (n = 215) were invited for colposcopy. Directed biopsies were obtained from 277 of 573 women at colposcopy. Those with moderate dysplasia or worse lesions diagnosed by histology were considered true-positives. Those with no lesions or with reactive or reparative changes at colposcopy and those for whom histology revealed no pathology, reactive or reparative changes, atypia, or mild dysplasia were considered false-positives. The detection rate of true-positive cases and the approximate specificity of the two tests were compared. RESULTS: VIA was positive in 298 women (9.8%), and cytology was positive (for atypia or worse lesions) in 307 women (10.2%). Of the 51 true-positive cases (20 cases of moderate dysplasia, 7 of severe dysplasia, 12 of carcinoma in situ, and 12 of invasive carcinoma), VIA detected 46 (90.1%) and cytology 44 (86.2%), yielding a sensitivity ratio of 1.05. VIA detected five lesions missed by cytology, and cytology detected three missed by VIA; both missed two lesions. The approximate specificities were 92.2% for VIA and 91.3% for cytology. The positive predictive value of VIA was 17.0%, and that of cytology was 17.2%. CONCLUSIONS: These results indicate that VIA and cytology had very similar performance in detecting moderate dysplasia or more severe lesions in this study. VIA merits further evaluation as a primary screening test in low-resource settings.