207591 Evaluation of visual inspection with acetic acid (VIA) adequacy with advancing age

Monday, November 9, 2009: 1:24 PM

Miriam Cremer, MD MPH , School of Medicine, Obstetrics and Gynecology, New York University, New York, NY
Mauricio Maza , Basic Health International, San Salvador, El Salvador
Matthew Siedhoff, MD , School of Medicine, Obstetrics and Gynecology, New York University, New York, NY
Veronica Lerner , School of Medicine, Obstetrics and Gynecology, New York University, New York, NY
Kimberley Bullard , School of Natural Science, Hampshire College, Amherst, MA
Elizabeth Conlisk , School of Natural Science, Hampshire College, Amherst, MA
Juan Felix, MD , USC, Los Angeles, CA
Background: Visual inspection with acetic acid (VIA) is a low-technology, single visit approach to cervical cancer screening which is gaining popularity in developing countries. Current guidelines suggest using VIA only in women under age 50 because of concerns about adequacy of this test in an older population.

Methods: In this ongoing study, women over age 50 in rural El Salvador presenting for cervical cancer screening were invited to undergo VIA and Pap smear. VIA was determined to be adequate or inadequate by each provider. VIA screening was considered adequate if the squamo-columnar junction could be fully visualized. VIA adequacy in younger women was determined from medical records of women under age 50 who were routinely screened using VIA.

Results: Preliminary results for 857 women indicate that VIA adequacy steadily declines with age. For respective age groups adequacy is the following: 20-29 = 98% (95% CI: 96-100%), 30-39= 93% (95% CI: 88-97%), 40-49= 85% (95% CI: 79-91%), 50-59= 81% (95% CI: 77-86%), 60-69= 72% (95% CI: 64-79%), and 70-79= 64% (95% CI: 51-77%).

Discussion: VIA adequacy declines in a linear fashion with age. Even in the oldest age group, however, VIA was adequate in the majority of women (64%). This may suggest that VIA is an appropriate screening method in all ages if the exam is adequate rather than using a strict age cut-off. Using this algorithm could decrease loss to follow-up, given the ease of a single visit approach. It will be important to correlate this data with predictive performance of VIA in older women.

Learning Objectives:
1. Describe what determines an adequate VIA exam 2. Describe the relationship between VIA adequacy and age 3. Evaluate current screening criteria for VIA in women over age 50

Keywords: Cancer Screening, Cervical Cancer

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: as a resident physician at NYU, I was actively involved in the data collection, analysis, and interpretation for this project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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