title: A comparative study of cervical cancer screening methods in a rural community setting of North India.
abstract: BACKGROUND
  Pap smear testing as a conventional cervical screening approach has limitations for implementation and aided visual cervical testing has varying results in different regions.
  
  
  OBJECTIVE
  The aim of this study is to demonstrate the performance of aided visual cervical screening tests as against conventional Pap smear testing in a rural community setting of North India.
  
  
  METHODS
  This was a rural community based cross-sectional study.
  
  
  METHODS
  All 7603 ever married women of age 30-59 years surveyed in a pocket of Dadri Tehsil, Uttar Pradesh, India were targeted for screening by Pap, visual inspection of cervix using acetic acid (VIA) and visual inspection of cervix using Lugol's iodine (VILI) methods. Screen positives were referred to colposcopy and confirmation by histology.
  
  
  METHODS
  Detection of histological cervical intraepithelial neoplasia (CIN) II + and CIN III + assessed separately by sensitivity, specificity and likelihood ratio's and predictive values. Analysis of data was performed by using IBM SPSS statstics software version 16.0.
  
  
  RESULTS
  A total of 65.6%(4988/7604) eligible women of 30-59 years age group in the target population were screened. Out of 4988, further analysis was performed on 4148 after excluding those who did not complete all screenings, who lost to follow-up and had missing histology results. Screen positivity rates by Pap (ASCUS and above), VIA and VILI were 2.6%, 9.7% and 13.5% respectively. Sensitivity and specificity of detecting the CIN III+ lesions were 87.5 and 98.8% for Pap, 50.0% and 96.7% for VIA and 50.0% and 95.7% for VILI respectively.
  
  
  CONCLUSIONS
  VIA screening demonstrated as a feasible primary screening test for detecting high grade CIN and as to perform better when the Pap test is not feasible.
authors.forename: L
authors.initials: L
authors.lastname: Satyanarayana
authors.affiliation: Departments of Epidemiology and Biostatistics and Cyto Pathology, Institute of Cytology and Preventive Oncology, Noida, Uttar Pradesh, India.
authors.forename: S
authors.initials: S
authors.lastname: Asthana
authors.forename: S
authors.initials: S
authors.lastname: Bhambani
authors.forename: P
authors.initials: P
authors.lastname: Sodhani
authors.forename: S
authors.initials: S
authors.lastname: Gupta
mesh_terms: D019342:Acetic Acid; D000328:Adult; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D007194:India; D007454:Iodides; D008875:Middle Aged; D012424:Rural Population; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*
chemical_list: D007454:Iodides; D019342:Acetic Acid; C010389:Lugol's solution