Odds ratio of cervical cancer in those with adequate negative screening compared with no screening at age 50–64 y by time since last screen.

<p>The line shows the log-linear trend, the shaded area shows the 95% confidence interval for the trend line, and the dots provide estimates based on data within 2 y of the <i>x</i>-axis values.</p

Subgroup analyses—odds ratios of cervical cancer at age 65–83 y for women with adequate negative screening relative to no screening at age 50–64 y.

<p>Subgroup analyses—odds ratios of cervical cancer at age 65–83 y for women with adequate negative screening relative to no screening at age 50–64 y.</p

Risk of cervical cancer according to screening history at age 50–64 y by age at diagnosis.

<p>Risk of cervical cancer according to screening history at age 50–64 y by age at diagnosis.</p

Estimated relative risks of cervical cancer associated with questionnaire-type risk factor data (e.g., economic deprivation, number of sexual partners, and smoking).

<p>Estimated relative risks of cervical cancer associated with questionnaire-type risk factor data (e.g., economic deprivation, number of sexual partners, and smoking).</p

Subgroup analyses—odds ratios of cervical cancer at age 65–79 y for women screened at least every 5.5 y at age 50–64 y relative to no screening at age 50–64 y.

<p>Subgroup analyses—odds ratios of cervical cancer at age 65–79 y for women screened at least every 5.5 y at age 50–64 y relative to no screening at age 50–64 y.</p

Odds ratio of cervical cancer at age 65–83 y in those with adequate negative screening compared with no screening at age 50–64 y by age at diagnosis.

<p>The line shows the log-linear trend, the shaded area shows the 95% confidence interval for the trend line, and the dots provide estimates based on data within 2 y of the <i>x</i>-axis values.</p

Risk of cervical cancer at age 65–79 y by maximum screening interval between the ages 50 and 64 y.

<p>Risk of cervical cancer at age 65–79 y by maximum screening interval between the ages 50 and 64 y.</p

Risk of cervical cancer at age 65–83 y by screening history at age 50–64 y and histological type.

<p>^a Adequate negative: last three tests were negative (at least one at age 60–64 y) and no high-grade (HSIL) or worse cytology since age 50. Sub-optimal but negative: not satisfying “adequate negative” but with either at least one negative test and no abnormal tests, or with three consecutive negatives and no HSIL but with the last test before age 60. Abnormal: HSIL cytology or a low-grade result (ASC-US or LSIL) not followed by three negatives. No screening: no test at age 50–64 y.</p

Number and percent of invasive cervical cancer cases by age, year of diagnosis, FIGO stage, and histology.

<p>Number and percent of invasive cervical cancer cases by age, year of diagnosis, FIGO stage, and histology.</p

Visual Inspection after Acetic Acid (VIA) Is Highly Heterogeneous in Primary Cervical Screening in Amazonian Peru

<div><p>Background</p><p>Conventional cytology (Pap) and visual inspection after the application of acetic acid (VIA) are currently used in primary screening in Peru. Studies suggest that the quality of VIA is highly variable. Over 36 000 women were screened with Pap and VIA in the TATI (Tamizaje y Tratamiento Inmediato de Lesiones Cervico-uterinas) project conducted in Amazonian Peru. Within a nested study to compare several screening techniques (C-TATI), a total of 5435 women were additionally screened with liquid-based cytology (LBC) and high-risk human papillomavirus testing (HR-HPV). We investigate the variation of positivity rates of VIA, Pap, LBC and HR-HPV in C-TATI and of VIA in the full TATI intervention.</p><p>Methods</p><p>At the screening visit, midwives collected three cervical samples for Pap, LBC and HC2 before performing VIA. The dispersion factor “D” (D = Pearson chi-square value/degrees-of-freedom) was used to measure the variability of tests results. Within C-TATI, the variability of positivity rates of VIA, Pap, LBC and HR-HPV was also graphically assessed with box- and scatter plots by midwife and month of screening. Funnel plots and smoothed scatter plots were used to correlate the variation of VIA by the number of examinations performed by each midwife over the full TATI intervention.</p><p>Results</p><p>Consistently over TATI, VIA results were highly variable, independently of the examiner, the time when the test was performed and the number of tests the examiner performed (D>6, <i>p</i>-values<0.001). In C-TATI, VIA results varied the most while those of HR-HPV varied the least (Ds>25, <i>p</i>-values<0.001 for VIA, Ds<1.6, <i>p</i>-values>0.05 for HR-HPV). No evidence for correlation between the number of VIAs done per midwife and the variability of VIA results was observed.</p><p>Conclusion</p><p>The lack of over-dispersion for HR-HPV detection suggests that the variable VIA results do not reflect true variation in underlying disease, but a lack of consistency in human judgement.</p></div