DOI QR코드

DOI QR Code

Effect of Screening on the Risk Estimates of Socio Demographic Factors on Cervical Cancer - A Large Cohort Study from Rural India

  • Published : 2013.01.31

Abstract

Background: Prospective cohort studies to determine cofactors with oncogenic HPV-infections for cervical cancer are very rare from developing countries and such data are limited to the few screening trials. Large screening trials provide such data as a by product. Some of the cases are prevented by screening and do not surface as invasive cancers at all. Also, pre-invasive lesions are detected almost entirely by screening. Screening causes selection bias if attendance in or effectiveness of screening is correlated with the risk factors. The aim of this study was to quantify the influence of screening on risk factors for cervical cancer. Materials and Methods: Our material stems from a rural cohort of 80,000 women subjected to a randomised screening trial. The effect of screening on the incidence of cervix cancer was estimated with reference to socio-demographic and reproductive risk factors of cervical cancer. We compared these risks with the incidence of cancer in the randomised control population by the same determinants of risk. Results: The results in the screening arm compared to the control arm showed that the women of low SES and young age were benefitting more than those of high SES and old age. The relative risk by age (30-39 vs 50-59) was 0.33 in the control arm and 0.24 in the screening arm. The relative risk by education (not educated vs educated) was 2.8 in the control arm and 1.8 in the screening arm. The previously married women did not benefit (incidence 113 and 115 per 100,000 women years in control vs screening arms) whereas the effect was substantial in those married (86 vs 54). Conclusions: The results in controls were consistent with the general evidence, but results in attenders and nonattenders of the screening arm showed that screening itself and self-selection in attendance and effectiveness can influence the effect estimates of risk factors. The effect of cervical cancer screening programmes on the estimates of incidence of cervical cancer causes bias in the studies on etiology and, therefore, they should be interpreted with caution.

References

  1. Sankaranarayanan R, Rajkumar R, Arrossi S, et al (2003). Determinants of participation of women in a cervical cancer visual screening trial in rural south India. Cancer Detect P rev, 27, 457-65. https://doi.org/10.1016/j.cdp.2003.09.006
  2. Sankaranarayanan R, Rajkumar R,Theresa R, et al (2004). Initial results from a randomised trial of cervical visual screening in rural south India. Int J Cancer, 109, 461-67. https://doi.org/10.1002/ijc.11726
  3. Sankaranarayanan R, Esmy PO, Rajkumar R, et al (2007). Effect of visual screening on cervical cancer incidence and mortality in Tamilnadu, India: a cluster randomised trial. Lancet, 370, 398-406. https://doi.org/10.1016/S0140-6736(07)61195-7
  4. Sankaranarayanan R, Bhatla N, Gravitt PE, et al(2008). Human papillomavirus infection and cervical cancer prevention in India, Bengladesh, Sri Lanka and Nepal. Vaccine, 26, 457-65.
  5. Sara CO, Peter B, Patricia J, Robert JT (2012). Personal factors influence use of cervical cancer screening services: Epidemiological survey and linked administrative data address the limitations of previous research. BMC Health Serv Res, 10, 34.
  6. Sellors JW, Sankaranarayanan R (2003). Colposcopy and treatment on Cervical Intraepithelial Neoplasia: A Beginners' Manual. IARC Press, Lyon, France.
  7. Singh S, Badaya S (2012). Factors influencing uptake of cervical cancer screening among women in India: a hospital based pilot study. J Community Med Health Educ, 2, 157.
  8. Stewart BW, Kleihues P (eds) (2003). World Cancer Report. IARC Press, Lyon, France.
  9. Weiss NS (2003). Adjusting for screening history in epidemiologic studies of cancer: why, when, and how to do it. Am J Epidemiol, 157, 957-61. https://doi.org/10.1093/aje/kwg062
  10. Aswathy S, Mariya AQ, Beteena K, Leelamoni K (2012). Cervical cancer screening: current knowledge and practice among women in a rural population of Kerala, India. Indian J Med Res, 136, 205-10.
  11. Crispin K, Susanne KK, Twalib N, et al (2012). Risk factors for VIA positivity and determinants of screening attendances in Dar es Salaam, Tanzania. BMC Public Health, 10, 1055.
  12. Ekta S, Shikha S, Vidya R, Dhiraj KS (2012). Awareness of cervical cancer screening among nursing staff in a tertiary institution of rural India. J Gynecol Oncol, 23, 141-6. https://doi.org/10.3802/jgo.2012.23.3.141
  13. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008:GLOBOCAN 2008. IntJ Ccancer, 127, 2893-917. https://doi.org/10.1002/ijc.25516
  14. Ferrera A, Velema JP, Figueroa M, et al (2000).Co-factors related to the causal relationship between human papillomavirus and invasive cervical cancer in Honduras. Int J Epidemiol, 29, 817-25. https://doi.org/10.1093/ije/29.5.817
  15. Frida SL, Tanya NB (2012). Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district in Tanzania: Three public policy implications. BMC Public Health, 10, 22.
  16. Laurie E, Monika K, Refik S, et al (2012). Socio demographic factors associated with cervical cancer screening and follow up of abnormal results. Can Fam Physician, 58, 22-31.
  17. Nene B, Jayanth K, Arrossi S, et al (2007). Determinants of women's participation in cervical cancer screening trial, Maharashtra, India. Bull World Health Organ, 85, 264-72. https://doi.org/10.2471/BLT.06.031195

Cited by

  1. Effect of Screening on Variation in Cervical Cancer Survival by Socioeconomic Determinants - a Study from Rural South India vol.16, pp.13, 2015, https://doi.org/10.7314/APJCP.2015.16.13.5237
  2. Use of Fast Transfer Analysis Cartridges for Cervical Sampling and Real Time PCR Based High Risk HPV Testing in Cervical Cancer Prevention - a Feasibility Study from South India vol.16, pp.14, 2015, https://doi.org/10.7314/APJCP.2015.16.14.5993
  3. Review of the Cervical Cancer Burden and Population-Based Cervical Cancer Screening in China vol.16, pp.17, 2015, https://doi.org/10.7314/APJCP.2015.16.17.7401
  4. Prevalence of Human Papillomavirus Types and Phylogenetic Analysis of HPV-16 L1 Variants from Southern India vol.16, pp.5, 2015, https://doi.org/10.7314/APJCP.2015.16.5.2073
  5. Diffusion weighted imaging in gynecological malignancies - present and future vol.8, pp.3, 2016, https://doi.org/10.4329/wjr.v8.i3.288