title: Clinical determinants of a positive visual inspection after treatment with acetic acid for cervical cancer screening.
abstract: OBJECTIVE
  To examine the determinants of a positive visual inspection after acetic acid (VIA), including the relationship of testing positive for high-risk human papillomavirus (HR-HPV), which is the necessary cause of cervical cancer.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Three clinical sites in rural China.
  
  
  METHODS
  A total of 7541 women aged 25-65 years.
  
  
  METHODS
  All women underwent VIA, DNA testing, by two DNA tests performed on both clinician- and self-collected specimens, and HPV E6 oncoprotein testing. Those positive by any test underwent colposcopy and four-quadrant biopsy evaluation. A random sample of women with negative screening results also underwent colposcopy and, if colposcopic abnormalities were observed, four-quadrant biopsy evaluation was performed. Women diagnosed with cervical intraepithelial neoplasia grade 2 (CIN2), or more severe grades (CIN2 + ), underwent treatment.
  
  
  METHODS
  Testing positive for VIA.
  
  
  RESULTS
  Overall, 7.6% (95% confidence interval, 95% CI, 7.0-8.2%) had a positive VIA. Women who tested positive for HPV were more likely to have a positive VIA than women who tested negative for HPV (15.0%, 95% CI 12.9-17.2% versus 6.3%, 95% CI 5.7-6.9%; P < 0.001). Older women were less likely to have a positive VIA (Ptrend  < 0.001), including women with CIN2 +  (Ptrend  < 0.001). A logistic regression model demonstrated that diagnosis (CIN2 +  versus <CIN2; odds ratio, OR, 32; 95% CI 11-100), testing HPV positive with a higher viral load (highest versus lowest; OR 4.3; 95% CI 2.5-7.4), and age (51 years and older versus <38 years; OR 0.22; 95% CI 0.17-0.30) were independent determinants of having a positive VIA. VIA was more likely to be positive for women with CIN2 + having an abnormal colposcopic impression versus women with CIN2 +  regardless of colposcopic impression (71.4 versus 47.2%).
  
  
  CONCLUSIONS
  The age of the population and method of disease ascertainment should be considered in the interpretation of any VIA performance.
authors.affiliation: Global Cancer Initiative, Chestertown, MD, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Castle
authors.forename: Y-L
authors.initials: YL
authors.lastname: Qiao
authors.forename: F-H
authors.initials: FH
authors.lastname: Zhao
authors.forename: W
authors.initials: W
authors.lastname: Chen
authors.forename: M
authors.initials: M
authors.lastname: Valdez
authors.forename: X
authors.initials: X
authors.lastname: Zhang
authors.forename: L-N
authors.initials: LN
authors.lastname: Kang
authors.forename: P
authors.initials: P
authors.lastname: Bansil
authors.forename: P
authors.initials: P
authors.lastname: Paul
authors.forename: P
authors.initials: P
authors.lastname: Bai
authors.forename: R
authors.initials: R
authors.lastname: Peck
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.forename: F
authors.initials: F
authors.lastname: Chen
authors.forename: J
authors.initials: J
authors.lastname: Jeronimo
mesh_terms: D019342:Acetic Acid; D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003127:Colposcopy / Q000379:methods; D004279:DNA, Viral / Q000302:isolation & purification; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D052162:Human papillomavirus 16 / Q000235:genetics / Q000302:isolation & purification; D052161:Human papillomavirus 18 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007202:Indicators and Reagents; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000401:mortality / Q000473:pathology*; D011446:Prospective Studies; D012424:Rural Population; D012680:Sensitivity and Specificity; D013048:Specimen Handling; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000401:mortality / Q000473:pathology*
chemical_list: D004279:DNA, Viral; D007202:Indicators and Reagents; D019342:Acetic Acid
keywords: Cervical cancer screening; cervical intraepithelial neoplasia; human papillomavirus; visual inspection after acetic acid