Early detection of cervical cancer by visual inspection: a population-based study in rural India.
A total of 3784 women aged 35 and above living in 26 villages in rural Maharashtra state, India, were invited to undergo a pelvic examination, to evaluate the performance of unaided visual inspection by trained paramedical workers in detecting cervical cancer. Of this number, 2135 (56.4%) women complied with the invitation. Paramedical workers scored 1120 (57.3%) and 118 (6%) women as having abnormal cervices using the low- and high-threshold criteria respectively. There was good agreement between the visual findings of the paramedical workers and those of a gynaecologist. All subjects had a cervical smear. A total of 10 cervical cancers were detected by cytology/histology. The sensitivity of visual inspection by paramedical workers to detect cervical cancer was 90.0% using the low threshold and 60.0% with the high threshold to define a positive test. The values for specificity were 42.8% and 94.5% respectively. The results obtained by the gynaecologist were very similar. Cost savings implied by limiting cytology/other investigations to approximately half of the population pre-selected on the basis of visual inspection are likely to be offset by the necessity to repeat the test at frequent intervals, repeated follow-up visits and other investigations.
Nene
B M
BM
Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Hospital, Barshi, Maharashtra, India.
Deshpande
S
S
Jayant
K
K
Budukh
A M
AM
Dale
P S
PS
Deshpande
D A
DA
Chiwate
A S
AS
Malvi
S G
SG
Deokar
S
S
Parkin
D M
DM
Sankaranarayanan
R
R
D000328:Adult; D000488:Allied Health Personnel; D002584:Cervix Uteri / Q000473:pathology*; D005260:Female; D006176:Gynecology; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010349:Patient Compliance; D015203:Reproducibility of Results; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology*