title: Risk of invasive cancer among women visually screened and colposcopy triaged by trained nurses in rural South India.
abstract: OBJECTIVE
  To estimate the long-term risk of cervical cancer among women screened by visual inspection with acetic acid (VIA) and to evaluate the benefit of additional colposcopy triage in rural south India.
  
  
  METHODS
  A retrospective analysis was conducted among 31 343 women who had undergone VIA at Dindigul district, India between January 1, 2000, and August 5, 2003, as part of a randomized screening trial. Women with positive VIA test results were offered colposcopy triage by trained nurses. Cervical cancer incidence data during follow-up (January 1, 2000, to December 31, 2012) were obtained from a regional cancer registry.
  
  
  RESULTS
  Among 3021 screen-positive women free of cancer at baseline, 2974 women underwent colposcopy; colposcopic abnormalities suggestive of precancerous lesions were detected among 2792 of these women (93.9%). Compared with the women with negative VIA screening results, the hazard ratio (HR) of cervical cancer during follow-up among the VIA-positive women without colposcopic abnormalities was 6.5 (95% confidence interval [CI], 1.6-27.1). The risk was similar among VIA-positive women with colposcopic abnormalities but without histological confirmation (HR5.2; 95% CI, 1.9-14.6).
  
  
  CONCLUSIONS
  The high risk of cancer among women without colposcopic abnormalities who tested positive by VIA suggested that screening without triage is potentially effective.
authors: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India; School of Health Sciences, University of Tampere, Tampereen Yliopisto, Finland.
authors: Jissa V
authors: JV
authors: Thulaseedharan
authors: School of Health Sciences, University of Tampere, Tampereen Yliopisto, Finland; Finnish Cancer Registry, Pieni Roobertinkatu, Helsinki, Finland.
authors: Nea
authors: N
authors: Malila
authors: Christian Fellowship Community Health Centre, Ambilikkai, Tamil Nadu, India.
authors: Pulikottil O
authors: PO
authors: Esmy
authors: Screening Group, International Agency for Research on Cancer, Lyon, France. Electronic address: muwonger@iarc.fr.
authors: Richard
authors: R
authors: Muwonge
authors: School of Health Sciences, University of Tampere, Tampereen Yliopisto, Finland; Finnish Cancer Registry, Pieni Roobertinkatu, Helsinki, Finland.
authors: Matti
authors: M
authors: Hakama
authors: Screening Group, International Agency for Research on Cancer, Lyon, France.
authors: Rengaswamy
authors: R
authors: Sankaranarayanan
mesh_terms: D019342:Acetic Acid; D000328:Adult; D003127:Colposcopy / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India; D007202:Indicators and Reagents; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D057184:Practice Patterns, Nurses'; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D012424:Rural Population; D014218:Triage / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology*; D014626:Vaginal Smears
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid
keywords: Cervical cancer; Cervical intraepithelial neoplasia; Colposcopy; Long-term risk; Screening; Visual inspection with acetic acid