- Volume 14 Issue 1
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Effect of Screening on the Risk Estimates of Socio Demographic Factors on Cervical Cancer - A Large Cohort Study from Rural India
- Thulaseedharan, Jissa Vinoda (Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology) ;
- Malila, Nea (School of Health Sciences, University of Tampere) ;
- Hakama, Matti (School of Health Sciences, University of Tampere) ;
- Esmy, Pulikottil Okuru (Christian Fellowship Community Health Centre) ;
- Cherian, Mary (Christian Fellowship Community Health Centre) ;
- Swaminathan, Rajaraman (Cancer Institute (WIA)) ;
- Muwonge, Richard (International Agency for Research on Cancer (IARC/WHO)) ;
- Sankaranarayanan, Rengaswami (International Agency for Research on Cancer (IARC/WHO))
- Published : 2013.01.31
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.
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- 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
- 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
- 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
- Diffusion weighted imaging in gynecological malignancies - present and future vol.8, pp.3, 2016, https://doi.org/10.4329/wjr.v8.i3.288