RESUMO
OBJECTIVE: To examine the determinants of a positive visual inspection after acetic acid (VIA), including the relationship of testing positive for high-risk human papillomavirus (HR-HPV), which is the necessary cause of cervical cancer. DESIGN: A prospective cohort study. SETTING: Three clinical sites in rural China. POPULATION: A total of 7541 women aged 25-65 years. METHODS: All women underwent VIA, DNA testing, by two DNA tests performed on both clinician- and self-collected specimens, and HPV E6 oncoprotein testing. Those positive by any test underwent colposcopy and four-quadrant biopsy evaluation. A random sample of women with negative screening results also underwent colposcopy and, if colposcopic abnormalities were observed, four-quadrant biopsy evaluation was performed. Women diagnosed with cervical intraepithelial neoplasia grade 2 (CIN2), or more severe grades (CIN2 + ), underwent treatment. MAIN OUTCOME MEASURE: Testing positive for VIA. RESULTS: Overall, 7.6% (95% confidence interval, 95% CI, 7.0-8.2%) had a positive VIA. Women who tested positive for HPV were more likely to have a positive VIA than women who tested negative for HPV (15.0%, 95% CI 12.9-17.2% versus 6.3%, 95% CI 5.7-6.9%; P < 0.001). Older women were less likely to have a positive VIA (Ptrend < 0.001), including women with CIN2 + (Ptrend < 0.001). A logistic regression model demonstrated that diagnosis (CIN2 + versus Assuntos
Ácido Acético
, Colposcopia
, Detecção Precoce de Câncer
, Indicadores e Reagentes
, Infecções por Papillomavirus/patologia
, Displasia do Colo do Útero/patologia
, Neoplasias do Colo do Útero/patologia
, Adulto
, Idoso
, China/epidemiologia
, Estudos de Coortes
, Colposcopia/métodos
, DNA Viral/isolamento & purificação
, Detecção Precoce de Câncer/métodos
, Feminino
, Papillomavirus Humano 16/genética
, Papillomavirus Humano 16/isolamento & purificação
, Papillomavirus Humano 18/genética
, Papillomavirus Humano 18/isolamento & purificação
, Humanos
, Programas de Rastreamento/métodos
, Pessoa de Meia-Idade
, Infecções por Papillomavirus/mortalidade
, Estudos Prospectivos
, População Rural
, Sensibilidade e Especificidade
, Manejo de Espécimes
, Neoplasias do Colo do Útero/mortalidade
, Esfregaço Vaginal
, Displasia do Colo do Útero/mortalidade