Clinical determinants of a positive visual inspection after treatment with acetic acid for cervical cancer screening

P. E. Castle*, Y. L. Qiao, F. H. Zhao, W. Chen, M. Valdez, X. Zhang, L. N. Kang, P. Bansil, P. Paul, P. Bai, R. Peck, J. Li, F. Chen, J. Jeronimo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)

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. Design A prospective cohort study. Setting Three clinical sites in rural China. Population 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. Main outcome measure 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.

Original languageEnglish
Pages (from-to)739-746
Number of pages8
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume121
Issue number6
DOIs
Publication statusPublished - May 2014
Externally publishedYes

Keywords

  • Cervical cancer screening
  • cervical intraepithelial neoplasia
  • human papillomavirus
  • visual inspection after acetic acid

Fingerprint

Dive into the research topics of 'Clinical determinants of a positive visual inspection after treatment with acetic acid for cervical cancer screening'. Together they form a unique fingerprint.

Cite this