INTRODUCTION:

Cervical cancer is the fourth most common cancer in women, and the seventh overall, with an estimated 528,000 new cases in 2012. There were an estimated 266,000 deaths from cervical cancer worldwide in 2012, accounting for 7.5% of all female cancer deaths. Almost nine of 10 (87%) cervical cancer deaths occur in the less-developed regions. Mortality varies 18-fold between the different regions of the world, with rates ranging from less than 2 per 100,000 in Western Asia, Western Europe and Australia/New Zealand to more than 20 per 100,000 in Melanesia (20.6/100,000) and Middle (22.2/100,000) and Eastern (27.6/100,000) Africa.^[1]

India has a population of 4,32,20 million women aged 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that every year 122,844 women are diagnosed with cervical cancer and that 67,477 women die from the disease. Cervical cancer ranks as the second most frequent cancer among women in India and the second most frequent cancer among women between 15 and 44 years of age.^[1] Studies performed in India so far have identified various risk factors contributing to cervical cancer. Some of the associated factors identified are illiteracy, poor personal hygiene, poor sanitation facilities, poor socioeconomic status, early marriage, multiparity, multiple sexual partners, etc.^,In India, among 4,32,20 million, the percentage of HPV prevalence was found to be 7.9%. Some of the risk factors reported were smoking prevalence of 2.8% and oral contraceptive use of 3.1%; the median age of the first sexual intercourse among women aged 25-49 years was 17.6 years.^[2]

STATEMENT OF THE PROBLEM:

A cross sectional study on efficacy of via in early detection of cervical cancer among women.

OBJECTIVES

To detect the early premalignant lesion of cervical cancer through VIA among women.

To determine the diagnostic efficacy of VIA in early detection of cervical cancer.

HYPOTHESIS 1

There will be significant effect in early detection of cervical cancer among women .through VIA.

RESEARCH METHODOLOGY:

Research methodology is a systematic way to solve the research problem .it consists of all general and specification activities from the identification of problem to final interpretation and conclusion. The rate methodology is to carry on the research work in a scientific and valid manner.

RESEARCH APPROACH

A research approach explains the researcher what data to be collected, how to analyze the data and suggest possible conclusion to be drawn from the data.

RESEARCH DESIGN

A descriptive cross sectional research design was selected for the current study.

RESEARCH SETTING

The present study was conducted in Melmaruvathur Adhiparasakthi Institute of Medical sciences and research Melmaruvathur at Kancheepuram District .

SAMPLING SIZE

50 women were selected.

SAMPLING TECNIQUE

The convenient sampling technique was used for sample selection.

SELECTION OF CRITETRIA:

INCLUSION CRITERIA

· Married women above 21 years who attend the gynaec out patient department

· Who are willing to participate in the study

EXCLUSION CRITERIA

· Women who underwent hysterectomy

· Women with invasive cancer

· Women above 70 years

Women	Screening procedure	Observation
50	VIA	Positive
50		negative

DESCRIPTION OF THE INSTRUMENT

The instrument was developed after the literature review and guidance from the experts.

In consists of three Parts

Part – I

It Consists of demographic variables such as, age, religion, education, occupation and income.

Part – II

It consists of reproductive history of women

Part – III

It consist of early detection of cervical cancer among women attending gnaec out patient department who fulfill the inclusion criteria. VIA used as diagnostic procedure in early detection of cervical cancer.

PROCEDURE

A formal written permission from the concerned authorities and a written consent from the women were obtained .Prior to the data collection permission was obtained from concerned authority of the organization for conducting the study .subjects were selected according to the selection criteria and confidentiality was maintained. Demographic and reproductive data was collected using structured questionnaire. Observation check list was in early detection of cervical cancer for VIA screening procedure.

A solution of 3% acetic acid was applied to cervix using a cotton swap. The cervix was then examined under 1-2 minutes under an adequate light source. The detection of any distinct acetowhite area was considered positive result. If no acetowhite areas, or if a whitish appearance is doubtful, the test result was considered negative. Positive for VIA were subjected to cervical biopsy for conformation.

DATA ANALYSIS:

The data was analyzed in terms of the objectives of the study using descriptive and inferential statistics. Demographic variables of women were analyzed in terms of frequency percentage.

Frequency and percentage of demographic variable

Sl. No	Demographic variables	Number	%
1.	Age in years a. 18-27	5	10%
	b. 28-37	18	36%
	c. 38-47	18	36%
	d. 48-57	7	14%
	e. 58-69	2	4%
2.	Education status a. Illiterate	22	44%
	b. Primary school	14	28%
	c. Secondary school	12	24%
	d. Graduate	2	4%
3.	Occupation a. Home maker	37	74%
	b. Business	-	-
	c. Employed	13	26%
4.	Family income a. Below Rs.3000	16	32%
	b. 3001 to 4000	18	36%
	c. 4001 to 5000	11	22%
	d. 5001 to above	5	10%
5.	Religion a. Hindu	44	88%
	b. Muslim	6	12%
	c. Christian	-
	d. Others	-
6.	Marital status a. Unmarried	-	-
	b. Married	42	84%
	c. Widow	8	16%

REPRODUCTIVE HISTORY

1.	Age at menarche a. 13-15	42	84%
1.	b. 16-18	8	16%
2.	Age at marriage. a. <18	4	8%
	b. ≥18-23	34	68%
	c. 24-29	12	24%
	d. 30-35	-	-
	e. 36-40	-	-
3.	Age at 1^st intercourse a. <18	4	8%
	b. ≤18	6	12%
	c. 19	14	28%
	d. 20	6	12%
	e. 21	4	8%
	f. 22	4	8%
	g. Above 24	12	24%
4.	Age at first delivery a. 18-22	38	76%
	b. 23-27	12	24%
	c. Above 27	-	-
5.	No. of children a. 1 child	-	-
	b. 2 children	14	28%
	c. 3 children	12	24%
	d. Above 4 children	24	48%
6.	Clinical symptoms a. Asymptomatic	6	12%
6.	b. Symptomatic	42	84%
7.	Awareness of Malignancy a. Yes	3	6%
7.	b. No	47	94%
8. 9.	Menstrual History a. Reg.28 day cycle	29	58%
	b. Irregular cycle	21	42%
	History of any infectious disease a. Yes	3	6%
	b. No	47	94%
10.	Papaniculou smear a. Satisfactory	48	96%
10.	b. Unsatisfactory	2	4%
11.	Pre-marital / Extra marital exposure a. Yes	-	-
11.	b. No	50	100

APPLICATION OF BAYES THEOREM IN DETERMINING DIAGNOSTIC EFFICACY

Subject classified according to disease status and test result.

Visual inspection of cervix by application of 3% acetic acid in early detection of cervical cancer among women.

VIA Test	Disease		Total
	+	–
+(4)	3	1	4
-(46)	Nil	46	46
Total	3	47	50

Sensitivity: true positive rate ; a÷a+c=3÷3+0=100%

Specificity; true negative rate ; d÷b+d =46÷1+46=97.8%

False negative rate; c÷a+c=0÷3+0=0%

False positive rate; b÷b+d=1÷1+46=2.1%

FIRST OBJECTIVE

To detect the early premalignant lesion of cervical cancer through VIA among women.

SECOND OBJECTIVE

To determine the diagnostic efficacy of VIA in early detection of cervical cancer.

The study result revealed that efficacy of VIA specificity 97.8%, sensitivity 100%, false negative rate 0% and false positive rate 2.1%. In VIA women no 4 (8%) were considered as positive and 3 (6%) was confirmed by biopsy report as cervical. women 46 (92%) were consider as negative for the test.

CONCLUSION:

In a developing nation like India VIA would be a possible alternative screening tool for early detection of cervical cancer. The use of acetic acid during visual examination of the cervix, termed visual inspection of cervix by application acetic acid (VIA) in early detection of cervical cancer has been advocated as an alternative screening method to PAP smears in developing countries. The attractive features of VIA include low cost, simple administration, immediate result and high specificity and sensitivity.

REFERENCES:

1. Ferlay J, Soerjomataram I, Ervik M. Globocan 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11.Lyon, France: International Agency for Research on Cancer, 2013. Available from: http://globocan.iarc.fr [Last accessed on 2014 Apr 12].

2. Bruni L, Barrionuevo-Rosas L, Serrano B, Brotons M, Cosano R, Muñoz J, et al. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in India. Summary Report 2014-03-17. [Last accessed on 2014 Apr 12].

3. Eronimo J, Morales O, Horna J, Pariona J, Manrique J, Rubiños J, Takahashi R. Visual inspection with acetic acid for cervical cancer screening outside of low-resource settings. Rev Panam Salud Publica. 2005;17(1):1–5

4. Usha Rani Poli, Indian J Community Med. 2015 Jul-Sep; 40(3): 203–207.

Received on 03.08.2015 Modified on 24.08.2015

Int. J. Adv. Nur. Management 3(4): Oct. - Dec. 2015; Page 325-328

DOI: 10.5958/2454-2652.2015.00026.8