Format

Send to

Choose Destination
Cancer Epidemiol Biomarkers Prev. 2010 May;19(5):1373-80. doi: 10.1158/1055-9965.EPI-09-1282.

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.

Author information

1
SHARE INDIA, Mediciti Institute for Medical Sciences, Ghanpur, India.

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.

PMID:
20447927
PMCID:
PMC2913449
DOI:
10.1158/1055-9965.EPI-09-1282
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center