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Indian J Cancer. 2004 Jan-Mar;41(1):32-6.

Visual inspection for cervical cancer screening: evaluation by doctor versus paramedical worker.

Author information

1
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi-110 029, India. nbhatla@aiims.ac.in

Abstract

BACKGROUND:

In the absence of an effective cervical cancer screening programme, efforts are being made to explore the feasibility of using the existing infrastructure to develop effective low-cost screening methods.

AIMS:

To evaluate and compare test performance of visual inspection of the cervix by a doctor and a paramedical worker.

SETTING AND DESIGN:

Gynaecology outpatient department (OPD), All India Institute of Medical Sciences, New Delhi; cross-sectional study.

MATERIAL AND METHODS:

One hundred women with complaints of vaginal discharge, irregular bleeding, post coital bleeding or unhealthy cervix underwent visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) by a doctor and nurse, followed by colposcopy and biopsy.

STATISTICAL ANALYSIS USED:

Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each test and compared. Concordance was determined by kappa statistics.

RESULTS:

VIA by nurse had a higher sensitivity (100% versus 87.5%), but lower specificity (53% versus 63%) when compared with the doctor, but it was not statistically significant. There was moderate agreement between their VIA findings (kappa=0.56). VILI findings were comparable to that of the VIA, both by the doctor and nurse. There was almost perfect agreement (kappa=0.89) between VILI by the doctor and nurse.

CONCLUSION:

Visual inspection can be performed reliably by trained paramedical workers and doctors and is an effective screening option in low resource settings.

PMID:
15105577
[Indexed for MEDLINE]
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