Article

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.

SHARE INDIA, Mediciti Institute for Medical Sciences, Ghanpur, India.
Cancer Epidemiology Biomarkers &amp Prevention (impact factor: 4.12). 05/2010; 19(5):1373-80. DOI:10.1158/1055-9965.EPI-09-1282
Source: PubMed

ABSTRACT 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.
We evaluated VIA positivity by demographics and reproductive history, results of clinical examination, and results from the other screening methods.
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%.
The interpretation of VIA is subjective and its performance cannot be readily evaluated against objective standards.
VIA is not a robust screening test and we caution against its use as the primary screening test in resource-limited regions.

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Keywords

Andhra Pradesh
 
apparent cervical inflammation
 
cervical cancer screening programs
 
cervical intraepithelial neoplasia grade 2
 
detection
 
human papillomavirus DNA testing
 
multivariate analysis
 
objective standards
 
Pap cytology
 
peri-urban area
 
population-based study
 
positivity
 
positivity rate varied
 
primary screening test
 
reproductive history
 
robust screening test
 
screening methods
 
study population
 
unknown cause
 
Visual inspection