CoChat
Sign Up
Cited by 63Cervical Cancer and HPV ResearchWomen's cancer prevention and managementGlobal Cancer Incidence and Screening

Implementing community-based cervical cancer screening programs using visual inspection with acetic acid in India: A systematic review

Open access
Adsul, Prajakta, Manjunath, Nitin, Srinivas, Vijaya, Arun, Anjali, Madhivanan, Purnima·2017·Cancer Epidemiology
DOI 10.1016/j.canep.2017.06.008PMC PMC5571735
Open this paper in CoChat — free account

Abstract

The objective of this review was to systematically appraise the existing published literature about community-based cervical cancer screening programs that have used visual inspection methods using acetic acid (VIA) in India. All peer reviewed journal articles till December 2015 were searched per PRISMA guidelines. Articles reporting results from cervical cancer screening programs in community-based settings, conducted in India, and using VIA were included in this review. The search resulted in 20 articles to be included in the review with a total of 313,553 women at 12 unique urban and rural sites across India. Seventeen (85%) studies were cross-sectional and three studies were randomized controlled trials; most studies compared accuracy of VIA with other screening tests such as visual inspection using Lugol's Iodine (VILI), HPV DNA, and cytology. Of studies that reported test accuracy for CIN Grade 2+, the VIA sensitivity values ranged from 16.6-82.6% and specificity ranged from 82.1-96.8%. Women between age groups of 30-59 years were recruited using motivational one-on-one counseling and local support staff. All studies conducted diagnostic follow-up using colposcopy and guided biopsies, when necessary. Three major themes were identified that facilitated implementation of screening programs in a community-based setting: standardized training that maintained competency of test providers; collaborations with community-based organizations that used health education for recruitment of participants; and employing the screen-and-treat method to reduce loss to follow-up. Summarized evidence presented in this review could substantially influence future implementation and sustainment of cervical cancer screening programs at a national level.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.canep.2017.06.008

Cites

3 of 3 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Studies from India have identified barriers to cervical cancer screening on several socioecological levels, including lack of knowledge, personal disbelief in prevention of cancer, lack of care-seeking when asymptomatic, lack of money for treatment, and reduced access to healthcare services.

    “Studies from India have identified barriers on several socioecological levels such as lack of knowledge, personal disbelief in prevention of cancer, lack of care-seeking when asymptomatic, lack of money for treatment, and reduced access to healthcare services [6–8].”

    From A community‐based, cross‐sectional study of hr<scp>HPV DNA</scp> self‐sampling‐based cervical cancer screening in rural Karnataka, India (2019) · cites this paper as [8]

    The Introduction reports low public awareness and few screening facilities in India, while Results > Implementation barriers and facilitators reports reluctance to visit a clinic when asymptomatic. These passages support several listed barriers, but the copy does not identify disbelief in cancer prevention or lack of money for treatment as barriers. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 45

  1. [2]Schiffman M Castle PE Jeronimo J Rodriguez AC Wacholder S Human papillomavirus and cervical cancer Lancet 370 9590 2007 890 907 17826171
  2. [3]Hariri S Markowitz LE Dunne EF Unger ER Population Impact of HPV Vaccines: Summary of Early Evidence Journal of Adolescent Health 53 6 2013 679 682 24263069 PMC7499050
  3. [4]Franco EL Cuzick J Hildesheim A de Sanjosé S Chapter 20: Issues in planning cervical cancer screening in the era of HPV vaccination Vaccine 24 Supplement 3 2006 S171 S177 16844268
  4. [5]Bhatla N Gulati A Mathur SR Rani S Anand K Muwonge R Sankaranarayanan R Evaluation of cervical screening in rural North India International Journal of Gynecology & Obstetrics 105 2 2009 145 149 19200539
  5. [6]Basu P Sankaranarayanan R Mandal R Roy C Das P Choudhury D Bhattacharya D Chatterjee R Dutta K Barik S Visual inspection with acetic acid and cytology in the early detection of cervical neoplasia in Kolkata, India International Journal of Gynecological Cancer 13 5 2003 626 632 14675346
  6. [7]Vesco KK Whitlock EP Eder M Lin J Burda MBU Senger CA Holmes RS Fu R Zuber S Screening for cervical cancer: a systematic evidence review for the US Preventive Services Task Force Lancet Oncol 12 7 2011 663 72 22132428
  7. [8]Sankaranarayanan R Nene BM Shastri SS Jayant K Muwonge R Budukh AM Hingmire S Malvi SG Thorat R Kothari A HPV screening for cervical cancer in rural India New England Journal of Medicine 360 14 2009 1385 1394 19339719
  8. [9]Basu P Ghoshal M Chattopadhyay K Mittal S Das P Choudhury D Chattopadhyay U Cervical screening by visual inspection with acetic acid (VIA) is well accepted by women-results from a community-based study in rural India Asian Pac J Cancer Prev 7 4 2006 604 608 17250436
  9. [10]Kumar Y Mishra G Gupta S Shastri S Cancer screening for women living in urban slums--acceptance and satisfaction Asian Pac J Cancer Prev 12 7 2011 1681 5 22126544
  10. [11]Sankaranarayanan R Esmy PO Rajkumar R Muwonge R Swaminathan R Shanthakumari S Fayette JM Cherian J Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial Lancet 370 9585 2007 398 406 17679017
  11. [13]Goldie SJ Gaffikin L Goldhaber-Fiebert JD Gordillo-Tobar A Levin C Mahé C Wright TC Cost-effectiveness of cervical-cancer screening in five developing countries New England Journal of Medicine 353 20 2005 2158 2168 16291985
  12. [15]Brownson RC Fielding JE Maylahn CM Evidence-based public health: a fundamental concept for public health practice Annual review of public health 30 2009 175 201 19296775
  13. [16]Moher D Liberati A Tetzlaff J Altman DG Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA StatementThe PRISMA Statement Annals of Internal Medicine 151 4 2009 264 269 19622511
  14. [17]Sankaranarayanan R Wesley R Somanathan T Dhakad N Shyamalakumary B Amma NS Parkin DM Nair MK Visual inspection of the uterine cervix after the application of acetic acid in the detection of cervical carcinoma and its precursors Cancer 83 10 1998 2150 2156 9827719
  15. [18]Sankaranarayanan R Wesley R Thara S Dhakad N Chandralekha B Sebastian P Chithrathara K Parkin DM Nair MK Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol’s iodine (VILI) in cervical cancer screening in Kerala, India International Journal of Cancer 106 3 2003 404 408 12845681
  16. [19]Sankaranarayanan R Basu P Wesley RS Mahe C Keita N Mbalawa CC Sharma R Dolo A Shastri SS Nacoulma M Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa International Journal of Cancer 110 6 2004 907 913 15170675
  17. [20]Sankaranarayanan R Shastri SS Basu P Mahé C Mandal R Amin G Roy C Muwonge R Goswami S Das P The role of low-level magnification in visual inspection with acetic acid for the early detection of cervical neoplasia Cancer detection and prevention 28 5 2004 345 351 15542259
  18. [21]Kamal MM Sapkal RU Sarodey CS Munshi MM Alsi YD Chande MA Hingway SR Dandige S Kane US Kshirsagar R Comparative study of four candidate strategies to detect cervical cancer in different health care settings Journal of Obstetrics and Gynaecology Research 33 4 2007 480 489 17688615
  19. [23]Sankaranarayanan R Rajkumar R Esmy PO Fayette JM Shanthakumary S Frappart L Thara S Cherian J Effectiveness, safety and acceptability of ‘see and treat’ with cryotherapy by nurses in a cervical screening study in India British journal of cancer 96 5 2007 738 43 17311015 PMC2360066
  20. [24]Gravitt PE Paul P Katki HA Vendantham H Ramakrishna G Sudula M Kalpana B Ronnett BM Vijayaraghavan K Shah KV Effectiveness of VIA, Pap, and HPV DNA testing in a cervical cancer screening program in a peri-urban community in Andhra Pradesh, India PLoS One 5 10 2010 e13711 21060889 PMC2965656
  21. [25]Deodhar K Sankaranarayanan R Jayant K Jeronimo J Thorat R Hingmire S Muwonge R Chiwate A Deshpande R Ajit D Accuracy of concurrent visual and cytology screening in detecting cervical cancer precursors in rural India International Journal of Cancer 131 6 2012 E954 E962 22581670
  22. [26]Basu P Mittal S Bhaumik S Mandal SS Samaddar A Ray C Siddiqi M Biswas J Sankaranarayanan R Prevalence of high-risk human papillomavirus and cervical intraepithelial neoplasias in a previously unscreened population—A pooled analysis from three studies International Journal of Cancer 132 7 2013 1693 1699 22907663
  23. [27]Jeronimo J Bansil P Lim J Peck R Paul P Amador JJ Mirembe F Byamugisha J Poli UR Satyanarayana L A multicountry evaluation of careHPV testing, visual inspection with acetic acid, and papanicolaou testing for the detection of cervical cancer International Journal of Gynecological Cancer 24 3 2014 576 585 24557438 PMC4047307
  24. [28]Satyanarayana L Asthana S Bhambani S Sodhani P Gupta S A comparative study of cervical cancer screening methods in a rural community setting of North India Indian J Cancer 51 2 2014 124 8 25104192
  25. [29]Basu P Mittal S Banerjee D Singh P Panda C Dutta S Mandal R Das P Biswas J Muwonge R Diagnostic accuracy of VIA and HPV detection as primary and sequential screening tests in a cervical cancer screening demonstration project in India International Journal of Cancer 137 4 2015 859 867 25631198
  26. [30]Poli UR Bidinger P Gowrishankar S Visual inspection with acetic acid (via) screening program: 7 years experience in early detection of cervical cancer and pre-cancers in rural South India Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine 40 3 2015 203 26170547 PMC4478664
  27. [31]Ghosh I Mittal S Banerjee D Singh P Dasgupta S Chatterjee S Biswas J Panda C Basu P Study of accuracy of colposcopy in VIA and HPV detection-based cervical cancer screening program Aust N Z J Obstet Gynaecol 54 6 2014 570 5 25476810
  28. [32]Shastri SS Mittra I Mishra G Gupta S Dikshit R Badwe RA Effect of visual inspection with acetic acid (VIA) screening by primary health workers on cervical cancer mortality: A cluster randomized controlled trial in Mumbai, India ASCO Annual Meeting Proceedings 2013 2
  29. [33]Thulaseedharan JV Malila N Hakama M Esmy PO Cheriyan M Swaminathan R Muwonge R Sankaranarayanan R Socio demographic and reproductive risk factors for cervical cancer-a large prospective cohort study from rural India Asian Pacific Journal of Cancer Prevention 13 6 2012 2991 2995 22938495
  30. [34]Vedantham H Silver MI Kalpana B Rekha C Karuna B Vidyadhari K Mrudula S Ronnett BM Vijayaraghavan K Ramakrishna G Determinants of VIA (Visual Inspection of the Cervix After Acetic Acid Application) positivity in cervical cancer screening of women in a peri-urban area in Andhra Pradesh, India Cancer Epidemiology Biomarkers & Prevention 19 5 2010 1373 1380 PMC2913449 20447927
  31. [35]Dinshaw K Mishra G Shastri S Badwe R Kerkar R Ramani S Thakur M Uplap P Kakade A Gupta S Determinants of compliance in a cluster randomised controlled trial on screening of breast and cervix cancer in Mumbai, India Oncology 73 3–4 2008 145 153 18408401
  32. [36]Dinshaw K Mishra G Shastri S Badwe R Kerkar R Ramani S Thakur M Uplap P Kakade A Gupta S Ganesh B Determinants of Compliance in a Cluster Randomised Controlled Trial on Screening of Breast and Cervix Cancer in Mumbai, India Oncology 73 3–4 2007 154 161 18408402
  33. [37]Mittra I Mishra GA Singh S Aranke S Notani P Badwe R Miller AB Daniel EE Gupta S Uplap P A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening International journal of cancer 126 4 2010 976 984 19697326
  34. [39]Ghosh P Gandhi G Kochhar P Zutshi V Batra S Visual inspection of cervix with Lugol’s iodine for early detection of premalignant & malignant lesions of cervix The Indian journal of medical research 136 2 2012 265 22960894 PMC3461739
  35. [41]Krishnan S Madsen E Porterfield D Varghese B Advancing Cervical Cancer Prevention in India: Implementation Science Priorities The Oncologist 18 12 2013 1285 1297 24217555 PMC3868423
  36. [42]Sauvaget C Fayette JM Muwonge R Wesley R Sankaranarayanan R Accuracy of visual inspection with acetic acid for cervical cancer screening International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 113 1 2011 14 24 21257169
  37. [44]Mahé C Gaffikin L Screening test accuracy studies: how valid are our conclusions? Application to visual inspection methods for cervical screening Cancer Causes & Control 16 6 657 666 16049804
  38. [45]Arbyn M Sankaranarayanan R Muwonge R Keita N Dolo A Mbalawa CG Nouhou H Sakande B Wesley R Somanathan T Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India International journal of cancer 123 1 2008 153 160 18404671
  39. [46]Mustafa RA Santesso N Khatib R Mustafa AA Wiercioch W Kehar R Gandhi S Chen Y Cheung A Hopkins J Systematic reviews and meta-analyses of the accuracy of HPV tests, visual inspection with acetic acid, cytology, and colposcopy International Journal of Gynecology & Obstetrics 2015 26851054
  40. [47]Sritipsukho P Thaweekul Y Accuracy of visual inspection with acetic acid (VIA) for cervical cancer screening: a systematic review Journal of the Medical Association of Thailand= Chotmaihet thangphaet 93 2010 S254 S261 21294423
  41. [48]Parashari A Singh V Reasons for variation in sensitivity and specificity of visual inspection with acetic acid (VIA) for the detection of pre- cancer and cancer lesions of uterine cervix Asian Pac J Cancer Prev 14 12 2013 7761 2 24460365
  42. [49]Mahé C Gaffikin L Screening test accuracy studies: how valid are our conclusions? Application to visual inspection methods for cervical screening Cancer Causes & Control 16 6 2005 657 666 16049804
  43. [50]Pretorius RG Kim RJ Belinson JL Elson P Qiao Y-L Inflation of sensitivity of cervical cancer screening tests secondary to correlated error in colposcopy Journal of lower genital tract disease 10 1 2006 5 9 16378026
  44. [51]Santesso N Mustafa RA Wiercioch W Kehar R Gandhi S Chen Y Cheung A Hopkins J Khatib R Ma B Mustafa AA Lloyd N Wu D Broutet N Schünemann HJ Systematic reviews and meta-analyses of benefits and harms of cryotherapy, LEEP, and cold knife conization to treat cervical intraepithelial neoplasia International Journal of Gynecology & Obstetrics 132 3 2016 266 271 26643302
  45. [52]Sankaranarayanan R ‘See-and-treat’works for cervical cancer prevention: what about controlling the high burden in India? The Indian journal of medical research 135 5 2012 576 22771586 PMC3401687

Cited by

Sorted by citations

Authors
Adsul, P., Manjunath, N., Srinivas, V., Arun, A., & Madhivanan, P.
Affiliations
  • Florida International University (US)
  • Public Health Research Institute Of India (IN)
Corresponding author
Adsul, Prajakta
ORCID
Venue
Cancer Epidemiology
Publisher
Elsevier BV
Published
2017-08
Volume
49
Pages
161-174
ISSN
1877-7821 (ISSN-L)
DOI
10.1016/j.canep.2017.06.008
PMC
PMC5571735
OpenAlex
W2735974985
Cited by
63
References
3
Citations by year
2026: 2 · 2025: 8 · 2024: 8 · 2023: 6 · 2022: 10 · 2021: 12 · 2020: 6 · 2019: 8 · 2018: 2 · 2017: 1
FWCI
0.62
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Cancer Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Florida International University Digital Commons (Florida International University) (submittedVersion)
Funders
  • National Institutes of Health (Z99 CA999999)
  • Fogarty International Center (R25TW009338, D43TW010540)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
cervical cancer screening, visual inspection with acetic acid, community-based screening program, India, screening accuracy, visual inspection with Lugol's iodine, HPV testing, cytology, motivational counseling, community organizations, screen-and-treat, loss to follow-up, colposcopy, provider training
MeSH terms
Adult, Uterine Cervical Neoplasms, Colposcopy, Community Health Services, Cross-Sectional Studies, Female, Humans, India, Iodides, Mass Screening, Middle Aged, Pregnancy, Acetic Acid, Early Detection of Cancer

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review