# Effect of VIA screening by primary health workers: randomized controlled study in Mumbai, India

Source: https://onco.cc/key-papers/paper-shastri-j-natl-cancer-inst/  
OnCo record `paper-shastri-j-natl-cancer-inst` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Paper cited by one trial page, indexed on Europe PMC as PubMed record 24563518 and published in JNCI: Journal of the National Cancer Institute; the citing page links this DOI, which is how the record was matched.

## Summary

Background: Cervical cancer is the leading cause of cancer mortality among women in India. Because Pap smear screening is not feasible in India, we need to develop effective alternatives.

Methods: A cluster-randomized controlled study was initiated in 1998 in Mumbai, India, to investigate the efficacy of visual inspection with acetic acid (VIA) performed by primary health workers in reducing cervical cancer mortality. Four rounds of cancer education and VIA screening were conducted at 24-month intervals in the screening group, whereas cancer education was offered once at entry to the control group. The study was planned for 16 years to include four screening rounds followed by four monitoring rounds. We present results after 12 years of follow-up. Poisson regression method was used to calculate the rate ratios (RRs); two-sided χ(2) was used to calculate the probability.

Results: We recruited 75360 women from 10 clusters in the screening group and 76178 women from 10 comparable clusters in the control group. In the screening group, we achieved 89% participation for screening and 79.4% compliance for diagnosis confirmation. The incidence of invasive cervical cancer was 26.74 per 100000 (95% confidence interval [CI] = 23.41 to 30.74) in the screening group and 27.49 per 100000 (95% CI = 23.66 to 32.09) in the control group. Compliance to treatment for invasive cancer was 86.3% in the screening group and 72.3% in the control group. The screening group showed a statistically significant 31% reduction in cervical cancer mortality (RR = 0.69; 95% CI = 0.54 to 0.88; P =.003).

Conclusions: VIA screening by primary health workers statistically significantly reduced cervical cancer mortality. Our study demonstrates the efficacy of an easily implementable strategy that could prevent 22000 cervical cancer deaths in India and 72600 deaths in resource-poor countries annually.

Indexed on Europe PMC as PubMed record 24563518 (DOI 10.1093/jnci/dju009). Matched by DOI alone: one trial page cites this DOI among its external links (the pages are listed under Related), and this page was written so that the citation resolves inside OnCo. No figure has been checked by an editor.

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Tags: europepmc-ingest
- Journal: JNCI: Journal of the National Cancer Institute
- Year: 2014
- DOI: 10.1093/jnci/dju009
- Authors: Shastri SS, Mittra I, Mishra GA, et al.
- What it means: One trial page on OnCo cites this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing page listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.
- Caveats: Matched to the citing OnCo records by DOI alone; the summary reproduces the Europe PMC abstract and no figure has been verified against the full paper.

## Sources

- J Natl Cancer Inst 2014: https://doi.org/10.1093/jnci/dju009
- PubMed: https://pubmed.ncbi.nlm.nih.gov/24563518/
- Europe PMC: https://europepmc.org/article/MED/24563518

## Connected records

- trials: [Mumbai VIA cervical screening trial (Tata Memorial)](https://onco.cc/trials/mumbai-via-screening/)
- journals: [JNCI: Journal of the National Cancer Institute](https://onco.cc/journals/jnci/)

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