Cargando…

Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India

BACKGROUND: While many studies have compared the efficacy of Pap cytology, visual inspection with acetic acid (VIA) and human papillomavirus (HPV) DNA assays for the detection cervical intraepithelial neoplasia and cancer, few have evaluated the program effectiveness. METHODS AND FINDINGS: A populat...

Descripción completa

Detalles Bibliográficos
Autores principales: Gravitt, Patti E., Paul, Proma, Katki, Hormuzd A., Vendantham, Haripriya, Ramakrishna, Gayatri, Sudula, Mrudula, Kalpana, Basany, Ronnett, Brigitte M., Vijayaraghavan, K., Shah, Keerti V.
Formato: Texto
Lenguaje:English
Publicado: Public Library of Science 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2965656/
https://www.ncbi.nlm.nih.gov/pubmed/21060889
http://dx.doi.org/10.1371/journal.pone.0013711
_version_ 1782189519229943808
author Gravitt, Patti E.
Paul, Proma
Katki, Hormuzd A.
Vendantham, Haripriya
Ramakrishna, Gayatri
Sudula, Mrudula
Kalpana, Basany
Ronnett, Brigitte M.
Vijayaraghavan, K.
Shah, Keerti V.
author_facet Gravitt, Patti E.
Paul, Proma
Katki, Hormuzd A.
Vendantham, Haripriya
Ramakrishna, Gayatri
Sudula, Mrudula
Kalpana, Basany
Ronnett, Brigitte M.
Vijayaraghavan, K.
Shah, Keerti V.
author_sort Gravitt, Patti E.
collection PubMed
description BACKGROUND: While many studies have compared the efficacy of Pap cytology, visual inspection with acetic acid (VIA) and human papillomavirus (HPV) DNA assays for the detection cervical intraepithelial neoplasia and cancer, few have evaluated the program effectiveness. METHODS AND FINDINGS: A population-based sample of 5603 women from Medchal Mandal in Andhra Pradesh, India were invited to participate in a study comparing Pap cytology, VIA, and HPV DNA screening for the detection of CIN3+. Participation in primary screening and all subsequent follow-up visits was rigorously tracked. A 20% random sample of all women screened, in addition to all women with a positive screening test result underwent colposcopy with directed biopsy for final diagnosis. Sensitivity, specificity, positive and negative predictive values were adjusted for verification bias. HPV testing had a higher sensitivity (100%) and specificity (90.6%) compared to Pap cytology (sensitivity  =  78.2%; specificity = 86.0%) and VIA (sensitivity = 31.6%; specificity = 87.5%). Since 58% of the sample refused involvement and another 28% refused colposcopy or biopsy, we estimated that potentially 87.6% of the total underlying cases of CIN3 and cancer may have been missed due to program failures. CONCLUSIONS: We conclude that despite our use of available resources, infrastructure, and guidelines for cervical cancer screening implementation in resource limited areas, community participation and non-compliance remain the major obstacles to successful reduction in cervical cancer mortality in this Indian population. HPV DNA testing was both more sensitive and specific than Pap cytology and VIA. The use of a less invasive and more user-friendly primary screening strategy (such as self-collected swabs for HPV DNA testing) may be required to achieve the coverage necessary for effective reduction in cervical cancer mortality.
format Text
id pubmed-2965656
institution National Center for Biotechnology Information
language English
publishDate 2010
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-29656562010-11-08 Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India Gravitt, Patti E. Paul, Proma Katki, Hormuzd A. Vendantham, Haripriya Ramakrishna, Gayatri Sudula, Mrudula Kalpana, Basany Ronnett, Brigitte M. Vijayaraghavan, K. Shah, Keerti V. PLoS One Research Article BACKGROUND: While many studies have compared the efficacy of Pap cytology, visual inspection with acetic acid (VIA) and human papillomavirus (HPV) DNA assays for the detection cervical intraepithelial neoplasia and cancer, few have evaluated the program effectiveness. METHODS AND FINDINGS: A population-based sample of 5603 women from Medchal Mandal in Andhra Pradesh, India were invited to participate in a study comparing Pap cytology, VIA, and HPV DNA screening for the detection of CIN3+. Participation in primary screening and all subsequent follow-up visits was rigorously tracked. A 20% random sample of all women screened, in addition to all women with a positive screening test result underwent colposcopy with directed biopsy for final diagnosis. Sensitivity, specificity, positive and negative predictive values were adjusted for verification bias. HPV testing had a higher sensitivity (100%) and specificity (90.6%) compared to Pap cytology (sensitivity  =  78.2%; specificity = 86.0%) and VIA (sensitivity = 31.6%; specificity = 87.5%). Since 58% of the sample refused involvement and another 28% refused colposcopy or biopsy, we estimated that potentially 87.6% of the total underlying cases of CIN3 and cancer may have been missed due to program failures. CONCLUSIONS: We conclude that despite our use of available resources, infrastructure, and guidelines for cervical cancer screening implementation in resource limited areas, community participation and non-compliance remain the major obstacles to successful reduction in cervical cancer mortality in this Indian population. HPV DNA testing was both more sensitive and specific than Pap cytology and VIA. The use of a less invasive and more user-friendly primary screening strategy (such as self-collected swabs for HPV DNA testing) may be required to achieve the coverage necessary for effective reduction in cervical cancer mortality. Public Library of Science 2010-10-28 /pmc/articles/PMC2965656/ /pubmed/21060889 http://dx.doi.org/10.1371/journal.pone.0013711 Text en This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. https://creativecommons.org/publicdomain/zero/1.0/ This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration, which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
spellingShingle Research Article
Gravitt, Patti E.
Paul, Proma
Katki, Hormuzd A.
Vendantham, Haripriya
Ramakrishna, Gayatri
Sudula, Mrudula
Kalpana, Basany
Ronnett, Brigitte M.
Vijayaraghavan, K.
Shah, Keerti V.
Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India
title Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India
title_full Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India
title_fullStr Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India
title_full_unstemmed Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India
title_short Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India
title_sort effectiveness of via, pap, and hpv dna testing in a cervical cancer screening program in a peri-urban community in andhra pradesh, india
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2965656/
https://www.ncbi.nlm.nih.gov/pubmed/21060889
http://dx.doi.org/10.1371/journal.pone.0013711
work_keys_str_mv AT gravittpattie effectivenessofviapapandhpvdnatestinginacervicalcancerscreeningprograminaperiurbancommunityinandhrapradeshindia
AT paulproma effectivenessofviapapandhpvdnatestinginacervicalcancerscreeningprograminaperiurbancommunityinandhrapradeshindia
AT katkihormuzda effectivenessofviapapandhpvdnatestinginacervicalcancerscreeningprograminaperiurbancommunityinandhrapradeshindia
AT vendanthamharipriya effectivenessofviapapandhpvdnatestinginacervicalcancerscreeningprograminaperiurbancommunityinandhrapradeshindia
AT ramakrishnagayatri effectivenessofviapapandhpvdnatestinginacervicalcancerscreeningprograminaperiurbancommunityinandhrapradeshindia
AT sudulamrudula effectivenessofviapapandhpvdnatestinginacervicalcancerscreeningprograminaperiurbancommunityinandhrapradeshindia
AT kalpanabasany effectivenessofviapapandhpvdnatestinginacervicalcancerscreeningprograminaperiurbancommunityinandhrapradeshindia
AT ronnettbrigittem effectivenessofviapapandhpvdnatestinginacervicalcancerscreeningprograminaperiurbancommunityinandhrapradeshindia
AT vijayaraghavank effectivenessofviapapandhpvdnatestinginacervicalcancerscreeningprograminaperiurbancommunityinandhrapradeshindia
AT shahkeertiv effectivenessofviapapandhpvdnatestinginacervicalcancerscreeningprograminaperiurbancommunityinandhrapradeshindia
AT effectivenessofviapapandhpvdnatestinginacervicalcancerscreeningprograminaperiurbancommunityinandhrapradeshindia