Early detection of cervical cancer by visual inspection: a population-based study in rural India

Int J Cancer. 1996 Dec 11;68(6):770-3. doi: 10.1002/(SICI)1097-0215(19961211)68:6<770::AID-IJC14>3.0.CO;2-4.


A total of 3784 women aged 35 and above living in 26 villages in rural Maharashtra state, India, were invited to undergo a pelvic examination, to evaluate the performance of unaided visual inspection by trained paramedical workers in detecting cervical cancer. Of this number, 2135 (56.4%) women complied with the invitation. Paramedical workers scored 1120 (57.3%) and 118 (6%) women as having abnormal cervices using the low- and high-threshold criteria respectively. There was good agreement between the visual findings of the paramedical workers and those of a gynaecologist. All subjects had a cervical smear. A total of 10 cervical cancers were detected by cytology/histology. The sensitivity of visual inspection by paramedical workers to detect cervical cancer was 90.0% using the low threshold and 60.0% with the high threshold to define a positive test. The values for specificity were 42.8% and 94.5% respectively. The results obtained by the gynaecologist were very similar. Cost savings implied by limiting cytology/other investigations to approximately half of the population pre-selected on the basis of visual inspection are likely to be offset by the necessity to repeat the test at frequent intervals, repeated follow-up visits and other investigations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Allied Health Personnel
  • Cervix Uteri / pathology*
  • Female
  • Gynecology
  • Humans
  • Mass Screening / methods*
  • Middle Aged
  • Patient Compliance
  • Reproducibility of Results
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / epidemiology*