Visual Inspection with Acetic Acid (VIA) vs Cervical Cytology as Cervical Cancer Screening Tools in South India
Subscribe/Renew Journal
Context: With a quarter of all cervical cancers occurring in India, the risk for women to contract this condition is high. The burden remains high because cervical screening programs of adequate scale are lacking.
Aims: To compare the performance of visual inspection with acetic acid and cervical cytology in south India.
Setting and Design: A cross-sectional study was performed in three villages in one of the south Indian district by recruiting 668 healthy women to undergo VIA and conventional Pap smear examination.
Method and Material: Women who had a positive result from any of these tests were subjected to colposcopy and biopsies (if necessary), and women with high-grade cervical intraepithelial neoplasia (CIN) were properly treated.
Statistical Analysis: Data was analyzed using statistical software from www.OpenEpi.com
Results: Overall test positivity was 21.4% for VIA and 2.24% for Pap smear (LSIL threshold), 1.04% for Pap smear (HSIL threshold). VIA was positive in 70% of the women with CIN 1, 75% of those with CIN 2, 66.66% of women with CIN 3 and in two of two (100%) of women with cancer. Approximately 10% of women with no detectable disease had an abnormal VIA.
Conclusions: A combined use of VIA with the Pap test allowed specific detection of cervical abnormalities.
Keywords
- Bhatla N, Gulati A, Mathur SR, Rani S, Anand K and Sankaranarayanan R et al. Evaluation of Cervical screening in rural north India. Int J Gyn and Obst. 2009;105:257-261.
- Parkin DM, Pisani P, Ferlay J. Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 1999;80:827–841.
- Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, CA Cancer J Clin, 2005;55: 74–108.
- Miller AB, Nazeer S, Fonn S, et al. Report on Consensus Conference on Cervical Cancer Screening and Management. Int J Cancer 2000;86:440–7.
- Ponten J, Adami H-O, Bergstro¨m R, et al. Strategies for global control of cervical cancer. Int J Cancer 1995;60:1–26.5.
- Sigurdsson K. The Icelandic and Nordic cervical screening programs: trends in incidence and mortality rates through 1995. Acta Obstet Gynecol Scand 1999;78:478–85.
- Cronje HS, Parham GP, Cooreman BF, et al. A comparison of four screening methods for cervical neoplasia in a developing country. Am J Obstet Gynecol 2003;188:395–400.
- Sankaranarayanan R, Wesley R, Somanathan T, et al. Visual inspection of the uterine cervix after the application of acetic acid in the detection of cervical carcinoma and its precursors. Cancer 1998;83:2150–15.
- University of Zimbabwe/JHPIEGO Cervical Cancer Project. Visual inspection with acetic acid for cervical screening: test qualities in a primary care setting. Lancet 1999;353:869–73.
- Sankaranarayanan R, Wesley R, Somanathan T, et al. Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol’s Iodine (VILI) in cervical cancer screening in Kerala, India. Int J Cancer 2003;106:404–8.
- Denny L, Kuhn L, Pollack A, et al. Evaluation of alternative methods of cervical cancer screening in resource poor settings. Cancer 2000;89:826–833.
- Denny L, Kuhn L, Pollack A, et al. Direct visual inspection for cervical cancer screening: an analysis of factors influencing test performance. Cancer 2002;94:1699–707.
- Sankaranarayanan R, Nene BM, Dinshaw K, et al. Early detection of cervical cancer with visual inspection methods: a summary of completed and on-going studies in India. Salud Publica Mex 2003;45:S399–407.
- Belinson JL, Pretorius RG, Zhang ZH, et al. Cervical cancer screening by simple visual inspection after acetic acid. Obstet Gynecol 2001;98:441–4.
- Solomon D, Davey D, Kurman R, et al. Forum Group Members; Bethesda 2001 Workshop. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002;287: 2114–2119.
- Sankaranarayanan R, Wesley R, Somanathan T, Dhakad N, Shyamalakumary B, Sreedevi Amma N et al. Visual inspection of the uterine cervix after the application of acetic acid in the detection of cervical carcinoma and its precursors. Cancer 1998;83:2150-2156.
- Sarian LO, Derchain SF, Naud P, Roteli-Martins C, Longatto-Filho A, Tatti S et al. Evaluation of visual inspection with acetic acid (VIA), Lugol’s iodine (VILI), cervical cytology and HPV testing as cervical screening tools in Latin America. J Med Screen 2005;12:142–149.
Abstract Views: 395
PDF Views: 0