Effect of Screening on Variation in Cervical Cancer Survival by Socioeconomic Determinants - a Study from Rural South India


Background: Socioeconomic factors are associated with screening in terms of reducing the risk of cervicalcancer. This study aimed to clearly establish the effect of screening on variation in socio-economic factor-specificsurvival estimates. Materials and
Methods: Survival estimates were calculated using the life table method for165 women from the routine care control arm and 67 from the visual inspection with acetic acid screening armdiagnosed with cervical cancer during 2000-2006 in rural south India. Kaplan-Meier survival curves were plottedto compare the variation in survival by socioeconomic factors.
Results: Whereas there was a significant variationin survival estimates of the different categories of age at diagnosis among the screen-detected cancers withwomen aged<50 years having an improved survival, no significant variation was noted among women diagnosedwith cervical cancer from the control arm. Compared to the variation among the cancer cases detected in theunscreened control group, screening widened the variation in survival estimates by age and type of house, andreduced the variation by education. The direction of the magnitude of the survival estimates was reversed withinthe different categories of occupation, marital status and household income in the screen-detected cancer casescompared 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 survivalrates in screened women aged <50 years, with no formal education, manual workers and married women.