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A study was conducted to evaluate the efficacy of a single round of human papillomavirus (HPV) screening in significantly reducing the number of advanced cervical cancers and mortality. Results indicated that such screening did help reduce mortality due to cervical cancer in rural India, in low-income settings.

Objective To determine the factors associated with participation in cervical cancer screening and follow-up treatment in the context of a randomized controlled trial. The trial was initiated to evaluate the efficacy and cost effectiveness of visual inspection with acetic acid, cytological screening and testing for human papillomavirus in reducing the incidence of and mortality from cervical cancer in Maharashtra, India. Methods Between October 1999 and November 2003 women aged 30-59 years were randomized to receive one of the three tests or to a control group. Participation was analysed for all three intervention arms. The differences between those who were screened versus those who were not was analysed according to the sociodemographic characteristics of the 100 800 eligible women invited for screening. Those who were treated versus those who were not were analysed according to the sociodemographic characteristics of the 932 women diagnosed with high-grade lesions. Participation in screening and compliance with treatment were also analysed according to the type of test used. Findings Compared with women who were not tested, screened women were younger (aged 30-39), better educated and had ever used contraception. A higher proportion of screened women were married and a lower proportion had never been pregnant Of the 932 women diagnosed with high-grade lesions or invasive cancer, 85.3% (795) received treatment. Women with higher levels of education, who had had fewer pregnancies and those who were married were more likely to comply with treatment. There were no differences in rates of screening or compliance with treatment when results were analysed by the test received. Conclusion Irrespective of the test being used, good participation levels for cervical cancer screening can be achieved in rural areas of developing countries by using appropriate strategies to deliver services. Communication methods and delivery strategies aimed at encouraging older, less-educated women, who have less contact with reproductive services, are needed to further increase screening uptake. Bulletin of the World Health Organization 2007;85:264-272. Resume Objectif Identifier les facteurs amenant les femmes a se soumettre a un depistage et a un traitement du cancer du col uterin dans le cadre d'un essai controle randomise. L'objectif de cet essai etait d'evaluer l'efficacite et le rapport cout/efficacite d'une inspection visuelle a l'acide acetique, d'un examen cytologique et d'un test de depistage du papillomavirus humain dans la reduction de l'incidence du cancer du col et de la mortalite due a cette maladie a Maharashtra en Inde. Methodes Entre octobre 1999 et novembre 2003, on a selectionne au hasard des femmes de 30 a 69 ans pour les soumettre a l'un des trois tests ou les integrer a un groupe temoin. La participation a ete etudiee pour chacun des trois bras d'intervention. Les differences entre les personnes testees et non testees ont ete analysees en fonction des caracteristiques sociodemographiques des 100 800 femmes remplissant les criteres d'inclusion dans l'essai et invitees a subir ce depistage. De meme, les differences entre les femmes traitees et non traitees ont ete analysees en fonction des caracteristiques sociodemographiques des 932 femmes chez lesquelles on avait diagnostique des lesions de haut grade. La participation au depistage et l'observance du traitement ont fait l'objet d'une analyse selon le type de test utilise. Resultats Par comparaison avec les femmes non testees, celles s'etant soumises a un depistage etaient plus jeunes (30 a 39 ans), presentaient un niveau d'education plus eleve et avaient fait usage d'une contraception. Parmi les personnes testees, on relevait aussi une proportion plus forte de femmes mariees et plus faible de femmes n'ayant jamais eu de grossesse. Chez les 932 femmes diagnostiquees comme porteuses de lesions de haut grade ou atteintes d'un cancer invasif, 85,3% (795) avaient recu un traitement. La plus forte probabilite d'observance du traitement s'observait chez les femmes possedant un bon niveau d'education, chez celles ayant eu jusque la un petit nombre de grossesses ou chez les femmes mariees. L'analyse en fonction du type de test subi n'a fait apparaitre aucune difference concernant les taux de depistage et d'observance du traitement. Conclusion Quel que soit le test employe, il est possible d'obtenir des taux de participation au depistage du cancer du col uterin satisfaisants dans les zones rurales des pays en developpement en appliquant des strategies de prestation des services appropriees. Pour accroitre encore le recours au test, des methodes de communication et des strategies de prestation de services, visant a encourager a se faire depister, les femmes plus agees et moins eduquees, ayant moins de contacts avec les services de sante genesique, sont necessaires. Resumen Objetivo Determinar los factores asociados a la participacion en el cribado y el tratamiento de seguimiento dei cancer cervicouterino en el contexto de un ensayo controlado aleatorizado. Se emprendio este ensayo a fin de evaluar la eficacia y la relacion costo/eficacia de la inspeccion visual con acido acetico, el cribado citologico y el analisis de la presencia de papilomavirus humano como medios para reducir la incidencia de cancer cervicouterino y la mortalidad por esa causa en Maharashtra, India. Metodos Entre octubre de 1999 y noviembre de 2003 se distribuyo aleatoriamente a una muestra de mujeres de 30 a 59 anos para que se sometiera a una de las tres pruebas o formara parte dei grupo testigo. Se analizo la participacion para los tres tipos de intervencion. Las diferencias entre las mujeres sometidas a cribado y las demas se analizaron en funcion de las caracteristicas sociodemograficas de las 100 800 mujeres elegibles invitadas a someterse al tamizaje. El analisis comparativo de las tratadas y las no tratadas se realizo en funcion de las caracteristicas sociodemograficas de las 932 mujeres a las que se les diagnosticaron lesiones de gran malignidad. La participacion en el cribado y el cumplimiento del tratamiento se analizaron tambien segun el tipo de prueba utilizada. Resultados En comparacion con las mujeres no sometidas a analisis, las mujeres cribadas eran mas jovenes (30-39 anos), tenian un mayor nivel de estudios y habian usado anticonceptivos con mas frecuencia. Una mayor proporcion de las mujeres sometidas a cribado estaban casadas, y una proporcion inferior no habia estado nunca embarazada. De las 932 mujeres a las que se les diagnosticaron lesiones de gran malignidad o cancer invasivo, el 85,3% (795) recibieron tratamiento. Las mujeres con mayor nivel de instruccion, que habian tenido menos embarazos y que estaban casadas tenian mas probabilidades de seguir el tratamiento. Cuando se procedio a analizar los resultados en funcion de la prueba realizada, no se observo ninguna diferencia en cuanto a las rasas de cribado o la observancia dei tratamiento. Conclusion Independientemente de la prueba utilizada, si se usan las estrategias apropiadas para dispensar los servicios, es posible lograr un buen nivel de participacion en el cribado del cancer cervicouterino. Si se desea aumentar la participacion en las iniciativas de cribado, se necesitan metodos de comunicacion y estrategias de prestacion de servicios que motiven a las mujeres de mas edad, con menor nivel de instruccion y con menor contacto con los servicios de atencion reproductiva., Introduction In developed countries, cervical cancer prevention programmes have been shown to be effective in reducing the incidence of and mortality from cervical cancer, while in developing countries, where these [...]

Objective Naked eye visual inspection with acetic acid (VIA), magnified VIA (VIAM), visual inspection with Lugol's iodine (VILI), cytology and human papillomavirus (HPV) testing were evaluated as screening methods for the detection of high-grade squamous intraepithelial lesions (HSIL) of the uterine cervix in a cross-sectional study in Mumbai, India. Methods Cytology, HPV testing, VIA, VIAM and VILI were carried out concurrently for 4039 women aged 30-65 years. All women were investigated with colposcopy and biopsies were taken from 939 women who had colposcopic abnormalities. The reference standard for final disease status was histology or negative colposcopy. The presence of HSIL was confirmed in 57 women (1.4%). The test characteristics for each method were calculated using standard formulae. Results The sensitivities of cytology, HPV testing, VIA, VIAM and VILI were 57.4%, 62.0%, 59.7%, 64.9%, and 75.4%, respectively (differences were not statistically significant). The specificities were 98.6%, 93.5%, 88.4%, 86.3%, and 84.3%, respectively. Adding a visual test to cytology or HPV testing in parallel combination resulted in a substantial increase in sensitivity, with a moderate decrease in specificity. The parallel combination of MILI and HPV testing resulted in a sensitivity of 92.0% and a specificity of 79.9%. Conclusion As a single test, cytology had the best balance of sensitivity and specificity. Visual tests are promising in low-resource settings, such as India. The use of both VIA and MILI may be considered where good quality cytology or HPV testing are not feasible. The sensitivity of cytology and HPV testing increased significantly when combined with VIA or VILI. Keywords Cervical intraepithelial neoplasia/diagnosis/pathology; Cervix neoplasms/diagnosis/pathology; Acetic acid/diagnostic use; Colposcopy/methods; DNA probes/diagnostic use, HPV; Mass screening/methods; Physical examination/methods; Sensitivity and specificity; Cross-sectional studies; India (source: MeSH, NLM). Mots cles Neoplasie cervicale intraepitheliale/diagnostic/anatomie pathologique/anatomie pathologique; Acide acetique/usage diagnostique; Colposcopie/methodes; Sondes ADN HPV/usage diagnostique; Depistage systematique/methodes; Examen physique/ methodes; Sensibilite et specificite (Epidemiologie); Etude section efficace; Inde (source : MeSH, INSERM). Palabras clave Neoplasia intraepitelial del cuello uterino/diagnostico/patologia; Neoplasmas del cuello uterino/diagnostico/patologia; Acido acetico/uso diagnostico; Colposcopia/metodos; Sondas ADN HPV/uso diagnostico; Tamizaje masivo/metodos; Examen fisico/ metodos; Sensibilidad y especificidad; Estudios transversales; India (fuente: DeCS, BIREME). [TEXT NOT REPRODUCIBLE IN ASCII.], Resume Evaluation en parallele de l'inspection visuelle, de l'examen cytologique et du test HPV comme methodes de depistage pour la detection precoce des neoplasies cervicales a Mumbai, Inde Objectif Dans [...]

Code Number: cn02009 ABSTRACT PURPOSE OF THE STUDY: To analyze the role of hypofractionated radiotherapy in advanced carcinoma of cervix. BASIC PROCEDURE: Medical records of 62 women with advanced carcinoma [...]

Abstract Background Set-up errors are an inherent part of radiation treatment process. Coverage of target volume is a direct function of set-up margins, which should be optimized to prevent inadvertent irradiation of adjacent normal tissues. The aim of this study was to evaluate three-dimensional (3D) set-up errors and propose optimum margins for target volume coverage in head and neck radiotherapy. Methods The dataset consisted of 93 pairs of orthogonal simulator and corresponding portal images on which 558 point positions were measured to calculate translational displacement in 25 patients undergoing conventional head and neck radiotherapy with antero-lateral wedge pair technique. Mean displacements, population systematic (Σ) and random (σ) errors and 3D vector of displacement was calculated. Set-up margins were calculated using published margin recipes. Results The mean displacement in antero-posterior (AP), medio-lateral (ML) and supero-inferior (SI) direction was -0.25 mm (-6.50 to +7.70 mm), -0.48 mm (-5.50 to +7.80 mm) and +0.45 mm (-7.30 to +7.40 mm) respectively. Ninety three percent of the displacements were within 5 mm in all three cardinal directions. Population systematic (Σ) and random errors (σ) were 0.96, 0.98 and 1.20 mm and 1.94, 1.97 and 2.48 mm in AP, ML and SI direction respectively. The mean 3D vector of displacement was 3.84 cm. Using van Herk's formula, the clinical target volume to planning target volume margins were 3.76, 3.83 and 4.74 mm in AP, ML and SI direction respectively. Conclusion The present study report compares well with published set-up error data relevant to head and neck radiotherapy practice. The set-up margins were

Byline: Kaustav. Talapatra, Tejpal. Gupta, Jai. Agarwal, Sarbani. Laskar, Shyam. Shrivastava, Ketayun. Dinshaw Squamous cell carcinoma of head and neck (SCCHN) is one of the commonest cancers seen in India, [...]