Browsing by Author "Muwonge, R"

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    Effect of screening on the risk estimates of socio demographic factors on cervical cancer - a large cohort study from rural India
    (Asian Pac J Cancer Prev., 2013-08) Jissa, VT; Malila, N; Hakama, M; Esmy, PO; Cherian, M; Swaminathan, R; Muwonge, R; Sankaranarayanan, R
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    Effect of Screening on Variation in Cervical Cancer Survival by Socioeconomic Determinants - a Study from Rural South India.
    (Asian Pac J Cancer Prev., 2015-09) Thulaseedharan, JV; Malila, N; Swaminathan, R; Esmy, PO; Cherian, M; Hakama, M; Muwonge, R; Sankaranarayanan, R
    Background: Socioeconomic factors are associated with screening in terms of reducing the risk of cervical cancer. This study aimed to clearly establish the effect of screening on variation in socio-economic factor-specific survival estimates. Materials and Methods: Survival estimates were calculated using the life table method for 165 women from the routine care control arm and 67 from the visual inspection with acetic acid screening arm diagnosed with cervical cancer during 2000-2006 in rural south India. Kaplan-Meier survival curves were plotted to compare the variation in survival by socioeconomic factors. Results: Whereas there was a significant variation in survival estimates of the different categories of age at diagnosis among the screen-detected cancers with women aged<50 years having an improved survival, no significant variation was noted among women diagnosed with cervical cancer from the control arm. Compared to the variation among the cancer cases detected in the unscreened control group, screening widened the variation in survival estimates by age and type of house, and reduced the variation by education. The direction of the magnitude of the survival estimates was reversed within the different categories of occupation, marital status and household income in the screen-detected cancer cases compared to control group cancer cases. Also, women diagnosed with stage 1 disease had a very good survival. Conclusions: Screening changed the pattern of survival by socio-economic factors. We found improved survival rates in screened women aged <50 years, with no formal education, manual workers and married women.
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    Risk of invasive cancer among women visually screened and colposcopy triaged by trained nurses in rural South India
    (Int J Gynaecol Obstet., 2015-09) Thulaseedharan, JV; Malila, N; Esmy, PO; Muwonge, R; Hakama, M; Sankaranarayanan, R
    Objective: To estimate the long-term risk of cervical cancer among women screened by visual inspection with acetic acid (VIA) and to evaluate the benefit of additional colposcopy triage in rural south India. Methods: A retrospective analysis was conducted among 31 343 women who had undergone VIA at Dindigul district, India between January 1, 2000, and August 5, 2003, as part of a randomized screening trial. Women with positive VIA test results were offered colposcopy triage by trained nurses. Cervical cancer incidence data during follow-up (January 1, 2000, to December 31, 2012) were obtained from a regional cancer registry. Results: Among 3021 screen-positive women free of cancer at baseline, 2974 women underwent colposcopy; colposcopic abnormalities suggestive of precancerous lesions were detected among 2792 of these women (93.9%). Compared with the women with negative VIA screening results, the hazard ratio (HR) of cervical cancer during follow-up among the VIA-positive women without colposcopic abnormalities was 6.5 (95% confidence interval [CI], 1.6–27.1). The risk was similar among VIA-positive women with colposcopic abnormalities but without histological confirmation (HR 5.2; 95% CI, 1.9–14.6). Conclusion: The high risk of cancer among women without colposcopic abnormalities who tested positive by VIA suggested that screening without triage is potentially effective.
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    Socio demographic and reproductive risk factors for cervical cancer - a large prospective cohort study from rural India
    (Asian Pac J Cancer Prev., 2013-02) Thulaseedharan, JV; Malila, N; Hakama, M; Esmy, PO; Cheriyan, M; Swaminathan, R; Muwonge, R; Sankaranarayanan, R