Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India 英文参考文献.docVIP

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Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India 英文参考文献.doc

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Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India 英文参考文献

EffectivenessofVIA,Pap,andHPVDNATestingina CervicalCancerScreeningPrograminaPeri-Urban CommunityinAndhraPradesh,India PattiE.Gravitt1,2*,PromaPaul1,HormuzdA.Katki3,HaripriyaVendantham4,GayatriRamakrishna5, MrudulaSudula4,BasanyKalpana4,BrigitteM.Ronnett6,K.Vijayaraghavan4,KeertiV.Shah2 forthe CATCHStudyTeam 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America, 2Department of Molecular MicrobiologyandImmunology,JohnsHopkinsBloombergSchoolofPublicHealth,Baltimore,Maryland,UnitedStatesofAmerica,3DivisionofCancerEpidemiologyand Genetics,NationalCancerInstitute,Bethesda,Maryland,UnitedStatesofAmerica,4SHAREINDIA,MedicitiInstituteforMedicalSciences,Ghanpur,India,5CenterforDNA FingerprintingandDiagnostics,Hyderabad,India,6DepartmentsofPathology andGynecologyandObstetrics,TheJohnsHopkinsUniversitySchoolofMedicineand Hospital,Baltimore,Maryland,UnitedStatesofAmerica Abstract Background:WhilemanystudieshavecomparedtheefficacyofPapcytology,visualinspectionwithaceticacid(VIA)and humanpapillomavirus(HPV)DNAassaysforthedetectioncervicalintraepithelialneoplasiaandcancer,fewhaveevaluated theprogrameffectiveness. MethodsandFindings:Apopulation-basedsampleof5603womenfromMedchalMandalinAndhraPradesh,Indiawere invited to participate in a study comparing Pap cytology, VIA, and HPV DNA screening for the detection of CIN3+. Participationinprimaryscreeningandallsubsequentfollow-upvisitswasrigorouslytracked.A20%randomsampleofall womenscreened,inadditiontoallwomenwithapositivescreeningtestresultunderwentcolposcopywithdirectedbiopsy for final diagnosis. Sensitivity, specificity, positive andnegative predictivevalues wereadjusted for verification bias.HPV testing had a higher sensitivity (100%) and specificity (90.6%) compared to Pap cytology (sensitivity = 78.2%; specificity=86.0%) and VIA (sensitivity=31.6%; specificity=87.5%). Since 58% of the sample refused involvement and another28%refusedcolposcopyorbiop