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.
OBJECTIVE
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.


CONCLUSIONS
VIA is not a robust screening test and we caution against its use as the primary screening test in resource-limited regions.
Vedantham
Haripriya
H
SHARE INDIA, Mediciti Institute for Medical Sciences, Ghanpur, India.
Silver
Michelle I
MI
Kalpana
B
B
Rekha
C
C
Karuna
B P
BP
Vidyadhari
K
K
Mrudula
S
S
Ronnett
Brigitte M
BM
Vijayaraghavan
K
K
Ramakrishna
Gayatri
G
Sowjanya
Pavani
P
Laxmi
Shantha
S
Shah
Keerti V
KV
Gravitt
Patti E
PE
D019342:Acetic Acid; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004279:DNA, Viral / Q000235:genetics; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007194:India; D007202:Indicators and Reagents / Q000494:pharmacology*; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics; D011379:Prognosis; D015996:Survival Rate; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology
D004279:DNA, Viral; D007202:Indicators and Reagents; D019342:Acetic Acid
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