EARLY DETECTION OF CERVICAL-CANCER BY VISUAL INSPECTION - A POPULATION-BASED STUDY IN RURAL INDIA

A total of 3784 women aged 35 and above living in 26 villages in rural Maharashtra state, India, were invited to undergo a pelvic examinatio n, to evaluate the performance of unaided visual inspection by trained paramedical workers in detecting cervical cancer. Of this number, 213 5 (56.4%) women complied with the invitation. Paramedical workers scor ed 1120 (57.3%) and 118 (6%) women as having abnormal cervices using t he low-and high-threshold criteria respectively. There was good agreem ent between the visual findings of the paramedical workers and those o f a gynaecologist. All subjects had a cervical smear. A total of 10 ce rvical cancers were detected by cytology/histology. The sensitivity of visual inspection by paramedical workers to detect cervical cancer wa s 90.0% using the low threshold and 60.0% with the high threshold to d efine a positive test. The values for specificity were 42.8% and 94.5% respectively. The results obtained by the gynaecologist were very sim ilar. Cost savings implied by limiting cytologylother investigations t o approximately half of the population pre-selected on the basis of vi sual inspection are likely to be offset by the necessity to repeat the test at frequent intervals, repeated follow-up visits and other inves tigations. (C) 1996 Wiley-Liss, Inc.