Analysis of the effectiveness of visual inspection with acetic acid/Lugol's iodine in one-time and annual follow-up screening in rural China.
OBJECTIVE
Via a large population-based survey conducted in rural, southwestern China, we aim to evaluate the effect of visual inspection with acetic acid/Lugol's iodine (VIA/VILI) on diagnosing cases of cervical cancer and of pre-cancerous lesions while exploring the mode of cervical prevention and control in low-resource settings in China.


METHODS
Women aged 30-59 years from Chongqing, China were recruited from 2006 to 2009. Participants underwent VIA/VILI, and, if positive, received colposcopy-directed or random biopsies. Women with negative VIA/VILI or biopsy-confirmed cervical intraepithelial neoplasia (CIN) 1 lesions diagnosed in the first round of screening were re-screened in the following year with the same procedure.


RESULTS
In total, 10,269 women received VIA/VILI. The average age of participants was 40.9 ± 7.6 years. Overall, 0.85% (87/10,269) of women were diagnosed via pathology-confirmed biopsy with CIN1, 0.25% (26/10,269) with CIN2, 0.27% (28/10,269) with CIN3, and 0.02% (2/10,269) with cervical cancer. Over half (57.7%) of CIN2 lesions, the majority of CIN3 lesions (89.3%), and all cancer cases (100%) were detected in the first round of screening.


CONCLUSIONS
In a rural, low-resource setting in China, one-time VIA/VILI screening detected more than a half of CIN2 cases, most CIN3 cases and all the cervical cancer cases. Detection rates of CIN2 lesions significantly increased with a 1-year follow-up VIA/VILI screen. Therefore, if multiple cervical cancer screenings are not feasible logistically or financially, a one-time VIA/VILI may be the most efficient strategy to detect cervical cancer and most CIN3 lesions in women in low-resource settings.
Department of Gynecological Oncology, Chongqing Cancer Institute/Hospital, 181 Hanyu Lane, Shapingba District, Chongqing 400030, People's Republic of China.
Rong
R
Li
Adam K
AK
Lewkowitz
Fang-Hui
FH
Zhao
Qi
Q
Zhou
Shang-Ying
SY
Hu
Hui
H
Qiu
Yan
Y
Zhang
Hong-Wei
HW
Jiang
Jin-Song
JS
Zhang
Ming
M
Li
Shao-Min
SM
Tong
Qiao-Yu
QY
Zhang
You-Lin
YL
Qiao
D019342:Acetic Acid; D000328:Adult; D002681:China; D004396:Coloring Agents; D003127:Colposcopy / Q000379:methods; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007454:Iodides; D008875:Middle Aged; D015995:Prevalence; D019035:Rural Health Services; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology
D004396:Coloring Agents; D007454:Iodides; D019342:Acetic Acid; C010389:Lugol's solution