title: Effect of Screening on Variation in Cervical Cancer Survival by Socioeconomic Determinants--a Study from Rural South India.
abstract: BACKGROUND
  Socioeconomic factors are associated with screening in terms of reducing the risk of cervical cancer. This study aimed to clearly establish the effect of screening on variation in socio-economic factor-specific survival estimates.
  
  
  METHODS
  Survival estimates were calculated using the life table method for 165 women from the routine care control arm and 67 from the visual inspection with acetic acid screening arm diagnosed with cervical cancer during 2000-2006 in rural south India. Kaplan-Meier survival curves were plotted to compare the variation in survival by socioeconomic factors.
  
  
  RESULTS
  Whereas there was a significant variation in survival estimates of the different categories of age at diagnosis among the screen-detected cancers with women aged<50 years having an improved survival, no significant variation was noted among women diagnosed with cervical cancer from the control arm. Compared to the variation among the cancer cases detected in the unscreened control group, screening widened the variation in survival estimates by age and type of house, and reduced the variation by education. The direction of the magnitude of the survival estimates was reversed within the different categories of occupation, marital status and household income in the screen-detected cancer cases compared to control group cancer cases. Also, women diagnosed with stage 1 disease had a very good survival.
  
  
  CONCLUSIONS
  Screening changed the pattern of survival by socio-economic factors. We found improved survival rates in screened women aged <50 years, with no formal education, manual workers and married women.
authors.affiliation: Achutha Menon Centre for Health Science Studies (AMCHSS), Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Chennai, India E-mail : MuwongeR@iarc.fr.
authors.forename: Jissa Vinoda
authors.initials: JV
authors.lastname: Thulaseedharan
authors.forename: Nea
authors.initials: N
authors.lastname: Malila
authors.forename: Rajaraman
authors.initials: R
authors.lastname: Swaminathan
authors.forename: Pulikottil Okuru
authors.initials: PO
authors.lastname: Esmy
authors.forename: Mary
authors.initials: M
authors.lastname: Cherian
authors.forename: Matti
authors.initials: M
authors.lastname: Hakama
authors.forename: Richard
authors.initials: R
authors.lastname: Muwonge
authors.forename: Rengaswamy
authors.initials: R
authors.lastname: Sankaranarayanan
mesh_terms: D000328:Adult; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control