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Risk of invasive cancer among women visually screened and colposcopy triaged by trained nurses in rural south India
Author(s) -
Thulaseedharan Jissa V.,
Malila Nea,
Esmy Pulikottil O.,
Muwonge Richard,
Hakama Matti,
Sankaranarayanan Rengaswamy
Publication year - 2015
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2014.11.019
Subject(s) - colposcopy , medicine , triage , obstetrics , cervical cancer , confidence interval , incidence (geometry) , cervix , cancer , hazard ratio , gynecology , emergency medicine , physics , optics
Objective To estimate the long‐term risk of cervical cancer among women screened by visual inspection with acetic acid (VIA) and to evaluate the benefit of additional colposcopy triage in rural south India. Methods A retrospective analysis was conducted among 31 343 women who had undergone VIA at Dindigul district, India between January 1, 2000, and August 5, 2003, as part of a randomized screening trial. Women with positive VIA test results were offered colposcopy triage by trained nurses. Cervical cancer incidence data during follow‐up (January 1, 2000, to December 31, 2012) were obtained from a regional cancer registry. Results Among 3021 screen‐positive women free of cancer at baseline, 2974 women underwent colposcopy; colposcopic abnormalities suggestive of precancerous lesions were detected among 2792 of these women (93.9%). Compared with the women with negative VIA screening results, the hazard ratio (HR) of cervical cancer during follow‐up among the VIA‐positive women without colposcopic abnormalities was 6.5 (95% confidence interval [CI], 1.6–27.1). The risk was similar among VIA‐positive women with colposcopic abnormalities but without histological confirmation (HR 5.2; 95% CI, 1.9–14.6). Conclusion The high risk of cancer among women without colposcopic abnormalities who tested positive by VIA suggested that screening without triage is potentially effective.