Clinical determinants of a positive visual inspection after treatment with acetic acid for cervical cancer screening
Article first published online: 28 FEB 2014
© 2014 Royal College of Obstetricians and Gynaecologists
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 121, Issue 6, pages 739–746, May 2014
How to Cite
Clinical determinants of a positive visual inspection after treatment with acetic acid for cervical cancer screening. BJOG 2014;121:739–746., , , , , , , , , , , , , .
- Issue published online: 17 APR 2014
- Article first published online: 28 FEB 2014
- Manuscript Accepted: 30 NOV 2013
- Bill & Melinda Gates Foundation
- Cervical cancer screening;
- cervical intraepithelial neoplasia;
- human papillomavirus;
- visual inspection after acetic acid
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.
A prospective cohort study.
Three clinical sites in rural China.
A total of 7541 women aged 25–65 years.
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.
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%).
The age of the population and method of disease ascertainment should be considered in the interpretation of any VIA performance.