{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:25:05Z","timestamp":1747182305807,"version":"3.40.5"},"reference-count":20,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T00:00:00Z","timestamp":1699228800000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe our experience of screening with visual inspection with acetic acid (VIA) and colposcopy to identify women with high\u2010grade precancerous cervical lesions who were candidates for cryotherapy. Women were screened to determine eligibility for a clinical trial testing the safety and efficacy of a new, simple and inexpensive cryotherapy device (CryoPop\u00ae) targeted for use in low and middle\u2010income countries (LMICs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Primary and urban health centres in Belagavi, Hubballi and Vijayapur, India.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women in the age\u2010group 30\u201349\u2009years, premenopausal, with no prior hysterectomy and no known HIV infection were eligible for screening.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Visual inspection with acetic acid was performed on eligible women following informed consent. VIA\u2010positive women were referred for colposcopy and biopsy. Biopsies were read by two pathologists independently, with a third pathologist acting as tie\u2010breaker if needed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>The primary outcome measures were the number\/proportion of women screening positive by VIA and the number\/proportion of those women screening VIA\u2010positive found to have high\u2010grade cervical lesions on biopsy (cervical intraepithelial neoplasia 2\/3 [CIN 2\/3]). Demographic variables were compared between women who screened VIA\u2010positive and those who screened VIA\u2010negative; a separate comparison of demographic and limited reproductive variables was performed between women who had CIN 2\/3 on biopsy and those without CIN 2\/3 on biopsy. Chi\u2010square or Fisher's exact tests for categorical data and<jats:italic>t<\/jats:italic>\u2010tests or analysis of variance for numeric data were used with all tests two\u2010sided and performed at an alpha 0.05 level of statistical significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 9130 women were screened with VIA between 4 July 2020 and 31 March 2021. The mean age of all women screened was 37\u2009years (standard deviation\u2009=\u20095.6\u2009years) with 6073 of the women (66.5%) in the 30\u201339\u2009year range. Only 1% of women reported prior cervical cancer screening. A total of 501 women (5.5%) were VIA\u2010positive; of these, 401 women underwent colposcopy. Of those who had colposcopy, 17 (4.2%) had high\u2010grade lesions on biopsy, an additional 164 (40.9%) had low\u2010grade cervical lesions on biopsy or endocervical curettage and one woman (0.2%) was found to have invasive cancer. VIA\u2010positive women were younger and had higher levels of education and income; however, women who were VIA\u2010positive and found to have CIN\u20092\/3 were older, were more likely to be housewives and had higher household income than those without CIN\u20092\/3.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite the COVID\u201019 pandemic, over 9100 women were screened with VIA for precancerous lesions. However, only 17 (4.2%) were found to have biopsy\u2010proven high\u2010grade cervical lesions, underscoring the subjective performance of VIA as a screening method. Given that this is significantly lower than rates reported in the literature, it is possible that the prevalence of high\u2010grade lesions in this population was impacted by screening a younger and more rural population. This study demonstrates that screening is feasible in an organised fashion and can be scaled up rapidly. However, while inexpensive and allowing for same\u2010day treatment, VIA may be too subjective and have insufficient accuracy clearly to identify lesions requiring treatment, particularly in low\u2010prevalence and low\u2010risk populations, calling into question its overall cost\u2010effectiveness.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17702","type":"journal-article","created":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T04:55:47Z","timestamp":1699332947000},"page":"158-167","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The CryoPop study: Screening for high\u2010grade cervical dysplasia in Karnataka, India"],"prefix":"10.1111","volume":"130","author":[{"given":"Jean R.","family":"Anderson","sequence":"first","affiliation":[{"name":"Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7691-9935","authenticated-orcid":false,"given":"S.","family":"Yogeshkumar","sequence":"additional","affiliation":[{"name":"Jawaharlal Nehru Medical College KLE Academy of Higher Education and Research Belagavi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enriquito","family":"Lu","sequence":"additional","affiliation":[{"name":"Jhpiego, an Affiliate of Johns Hopkins University Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gayane","family":"Yenokyan","sequence":"additional","affiliation":[{"name":"Johns Hopkins University Bloomberg School of Public Health Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katrina","family":"Thaler","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret","family":"Mensa","sequence":"additional","affiliation":[{"name":"Jhpiego, an Affiliate of Johns Hopkins University Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santosh","family":"Chikaraddi","sequence":"additional","affiliation":[{"name":"Karnataka Cancer Therapy &amp; Research Institute Hubballi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laxmikant","family":"Lokare","sequence":"additional","affiliation":[{"name":"Karnataka Institute of Medical Sciences Hubballi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muttappa R.","family":"Gudadinni","sequence":"additional","affiliation":[{"name":"BLDE (Deemed\u2010to\u2010be\u2010University) Shri B M Patil Medical College Hospital and Research Centre Vijayapura India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramalingappa","family":"Antartani","sequence":"additional","affiliation":[{"name":"Karnataka Institute of Medical Sciences Hubballi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kasturi","family":"Donimath","sequence":"additional","affiliation":[{"name":"Karnataka Institute of Medical Sciences Hubballi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Basavaraj","family":"Patil","sequence":"additional","affiliation":[{"name":"Karnataka Cancer Therapy &amp; Research Institute Hubballi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shailaja","family":"Bidri","sequence":"additional","affiliation":[{"name":"BLDE (Deemed\u2010to\u2010be\u2010University) Shri B M Patil Medical College Hospital and Research Centre Vijayapura India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shivaprasad S.","family":"Goudar","sequence":"additional","affiliation":[{"name":"Jawaharlal Nehru Medical College KLE Academy of Higher Education and Research Belagavi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Derman","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita","family":"Dalal","sequence":"additional","affiliation":[{"name":"Jawaharlal Nehru Medical College KLE Academy of Higher Education and Research Belagavi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"The CryoPop Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,11,6]]},"reference":[{"key":"e_1_2_13_2_1","first-page":"E197","article-title":"Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative","volume":"11","author":"Singh D","year":"2023","journal-title":"Lancet"},{"key":"e_1_2_13_3_1","unstructured":"World Health Organization Geneva.Global strategy to accelerate the elimination of cervical cancer as a public health problem [cited 2023 Mar 3]. Available from:https:\/\/www.who.int\/publications\/i\/item\/9789240014107"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1158\/1940-6207.CAPR-11-0540"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61195-7"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40944-021-00526-8"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2010.10.012"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.31557\/APJCP.2022.23.2.399"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.29458"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-1055"},{"key":"e_1_2_13_11_1","doi-asserted-by":"crossref","first-page":"86","DOI":"10.4103\/ijcm.IJCM_73_17","article-title":"Cross\u2010sectional study on visual inspection with acetic acid and pap smear positivity rates according to sociodemographic factors among rural married women of Bareilly (Utter Pradesh)","volume":"43","author":"Arun R","year":"2018","journal-title":"Indian J Community Med"},{"key":"e_1_2_13_12_1","first-page":"510","article-title":"Risk of several cancers is higher in urban areas after adjusting for socioeconomic status. Results from a two\u2010country population\u2010based study of 18 common cancers","volume":"9","author":"Harp L","year":"2014","journal-title":"J Urban Health"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0000000000000525"},{"key":"e_1_2_13_14_1","first-page":"4","article-title":"Cervical cancer: formulation and implementation of Govt of India guidelines for screening and management Indian J","volume":"20","author":"Mehrotra R","year":"2022","journal-title":"Gynecol Oncol"},{"key":"e_1_2_13_15_1","unstructured":"School of Public Health Postgraduate Institute of Medical Education and Research Chandigarh (India).Health technology assessment of strategies for cervical cancer screening in India [cited 2023 Mar 12]. 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