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Cancer Epidemiol Biomarkers Prev ; 19(5): 1373-80, 2010 May.
Article in English | MEDLINE | ID: mdl-20447927

ABSTRACT

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.


Subject(s)
Acetic Acid , Early Detection of Cancer , Indicators and Reagents/pharmacology , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Neoplasms/diagnosis , Adult , Aged , Aged, 80 and over , DNA, Viral/genetics , Female , Humans , India , Middle Aged , Papanicolaou Test , Papillomaviridae/genetics , Prognosis , Survival Rate , Urban Population , Uterine Cervical Neoplasms/virology , Vaginal Smears , Uterine Cervical Dysplasia/virology
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