Risk of invasive cancer among women visually screened and colposcopy triaged by trained nurses in rural south India

Thulaseedharan, Jissa Vinoda; Malila, Nea; Esmy, Pulikottil Okkuru; Muwonge, Richard; Hakama, Matti; Sankaranarayanan, Rengaswamy

doi:10.1016/j.ijgo.2014.11.019

Cited by 4 publications

(4 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…12 In a randomized controlled trial in India, the risk of invasive cancer among VIA-positive women with apparently normal colposcopy and histopathology during 12 years of follow-up was much higher than that of VIA-negative women (hazard ratio 6.5; 95% CI, 1.6-27.1). 13 The risk was similar to that observed in VIA-positive women with colposcopically detected abnormalities who did not undergo biopsy or treatment, thus demonstrating the futility of colposcopy in this scenario.…”

Section: Referral To Confirmatory Colposcopysupporting

confidence: 66%

“…In the atypical cells of undetermined significance, low‐grade squamous intraepithelial lesion (ASCUS‐LSIL) Triage Study (ALTS), the sensitivity of baseline colposcopy for the subsequent detection of CIN 3+ was only 53% . In a randomized controlled trial in India, the risk of invasive cancer among VIA‐positive women with apparently normal colposcopy and histopathology during 12 years of follow‐up was much higher than that of VIA‐negative women (hazard ratio 6.5; 95% CI, 1.6–27.1) . The risk was similar to that observed in VIA‐positive women with colposcopically detected abnormalities who did not undergo biopsy or treatment, thus demonstrating the futility of colposcopy in this scenario.…”

Section: Referral To Confirmatory Colposcopymentioning

confidence: 75%

See 1 more Smart Citation

Management algorithms for cervical cancer screening and precancer treatment for resource‐limited settings

Basu

Meheus

Chami

et al. 2017

Intl J Gynecology & Obste

Self Cite

View full text Add to dashboard Cite

Management algorithms for screen-positive women in cervical cancer prevention programs have undergone substantial changes in recent years. The WHO strongly recommends human papillomavirus (HPV) testing for primary screening, if affordable, or if not, then visual inspection with acetic acid (VIA), and promotes treatment directly following screening through the screen-and-treat approach (one or two clinic visits). This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

show abstract

Section: Referral To Confirmatory Colposcopysupporting

confidence: 66%

Section: Referral To Confirmatory Colposcopymentioning

confidence: 75%

Management algorithms for cervical cancer screening and precancer treatment for resource‐limited settings

Basu

Meheus

Chami

et al. 2017

Intl J Gynecology & Obste

Self Cite

View full text Add to dashboard Cite

show abstract

“…By implication, the Musoma, Bukumbi, and Shinyanga districts will have to be targeted with greater screening intensity. A disappointing finding is that none of these determinants is known to be favourably associated with the uptake of cervical screening in sub-Saharan Africa (as is the case for contraceptive use, for example) (Thulaseedharan et al 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Setting up a community-based cervical screening service in a low-income country: a pilot study from north-western Tanzania

Masalu

Serra

Amadori

et al. 2017

Int J Public Health

View full text Add to dashboard Cite

ObjectivesTo report the results of a pilot study for a service for cervical cancer screening and diagnosis in north-western Tanzania.MethodsThe pilot study was launched in 2012 after a community-level information campaign. Women aged 15–64 years were encouraged to attend the district health centres. Attendees were offered a conventional Pap smear and a visual inspection of the cervix with acetic acid (VIA).ResultsThe first 2500 women were evaluated. A total of 164 women (detection rate 70.0/1000) were diagnosed with high-grade cervical intraepithelial neoplasia and invasive cervical cancer. The performance of VIA was comparable to that of Pap smear. The district of residence, a history of untreated sexually transmitted disease, an HIV-negative status (inverse association), and parity were independently associated with the detected prevalence of disease. The probability of invasive versus preinvasive disease was lower in HIV-positive women and in women practicing breast self-examination.ConclusionsThe diagnostic procedure had an acceptable level of quality. Factors associated with the detected prevalence of disease will allow for a more targeted promotion of the service. Cervical screening should be coordinated with sexually transmitted disease and HIV infection control activities.

show abstract

“…An earlier study from India observed very low risk of developing cervical cancer in women with histopathology‐proved CIN1 after colposcopy . However, the women in the study were screened with visual inspection after acetic acid application (VIA) and the HPV status of the women at baseline was unknown.…”

mentioning

confidence: 99%

Risk of high‐grade precancerous lesions and invasive cancers in high‐risk HPV‐positive women with normal cervix or CIN 1 at baseline—A population‐based cohort study

Mittal

Basu

Muwonge

et al. 2017

Intl Journal of Cancer

Self Cite

View full text Add to dashboard Cite

Infection with high-risk human papillomavirus (HR-HPV) is transient and clears on its own in majority of the women. Only a few women who have persistent infection may finally develop cervical intraepithelial neoplasia (CIN) or cervical cancer in later years. The risk of progression in the HR-HPV-positive women with normal cervix or low-grade lesion on colposcopy and histopathology at baseline is less studied. We performed a longitudinal study on 650 HR-HPV-positive women with colposcopy and/or histopathology-proved normal or CIN1 diagnosis at baseline to assess the cumulative risk of development of high-grade CIN. After a mean follow-up of 2.1 person years of observation (PYO) (range 0.1-5.1), the cumulative incidence of CIN2+ (6.4%; 3.0/100 PYO) was significantly higher in women who had persistent HR-HPV infection compared to those who cleared the infection (adjusted HR 6.28; 95% CI 2.87-13.73). The risk of viral persistence in women aged 50-60 years was two times higher compared to women aged 40-49 years and three times higher compared to women aged 30-39 years. The probability of having persistent infection increased progressively with higher viral load at baseline (adjusted HR 3.29, 95% CI 2.21-4.90 for RLU ≥100; adjusted HR 2.69, 95% CI 1.71-4.22 for RLU 10-100). Women with increasing viral load at follow-up had four times higher risk of developing CIN2 or worse lesions as compared to those with decreasing load (20.9% vs 4.8%; p< 0.001). In the context of developing countries where cytology or genotyping triaging is not feasible, colposcopy referral of HR-HPV-positive women with advancing age, viral persistence, and increasing viral load may be considered.

show abstract

Risk of invasive cancer among women visually screened and colposcopy triaged by trained nurses in rural south India

Abstract: The high risk of cancer among women without colposcopic abnormalities who tested positive by VIA suggested that screening without triage is potentially effective.

Cited by 4 publications

References 21 publications

Management algorithms for cervical cancer screening and precancer treatment for resource‐limited settings

Management algorithms for cervical cancer screening and precancer treatment for resource‐limited settings

Setting up a community-based cervical screening service in a low-income country: a pilot study from north-western Tanzania

Risk of high‐grade precancerous lesions and invasive cancers in high‐risk HPV‐positive women with normal cervix or CIN 1 at baseline—A population‐based cohort study

Contact Info

Product

Resources

About