title: Early detection of cervical cancer by visual inspection: a population-based study in rural India.
abstract: 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.
authors.affiliation: Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Hospital, Barshi, Maharashtra, India.
authors.forename: B M
authors.initials: BM
authors.lastname: Nene
authors.forename: S
authors.initials: S
authors.lastname: Deshpande
authors.forename: K
authors.initials: K
authors.lastname: Jayant
authors.forename: A M
authors.initials: AM
authors.lastname: Budukh
authors.forename: P S
authors.initials: PS
authors.lastname: Dale
authors.forename: D A
authors.initials: DA
authors.lastname: Deshpande
authors.forename: A S
authors.initials: AS
authors.lastname: Chiwate
authors.forename: S G
authors.initials: SG
authors.lastname: Malvi
authors.forename: S
authors.initials: S
authors.lastname: Deokar
authors.forename: D M
authors.initials: DM
authors.lastname: Parkin
authors.forename: R
authors.initials: R
authors.lastname: Sankaranarayanan
mesh_terms: 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*