Evaluation of visual inspection as the primary screening method in a four-year cervical (pre-) cancer screening program in rural China

The aim of the study is to evaluate the feasibility of visual inspection with acetic acid/Lugol's iodine (VIA/VILI) as a primary screening method for cervical lesions in low-resource settings in China. Participants underwent VIA/VILI, and, if positive, received colposcopy and direct biopsy of visible lesions. Women who were negative for VIA/VILI or who were diagnosed with cervical intraepithelial neoplasia (CIN) 1 were re-screened the following year with the same procedure. In total, 10,269 women received VIA/VILI (of whom 8263, twice). Overall test positivity was 8.07% (1495/18532) for VIA/VILI, 33.44% (500/1495) for colposcopy, and the incidence of pathology-confirmed CIN1, CIN2/3 and cervical cancer was 0.85% (87/10,269), 0.53% (54/10,269) and 0.02% (2/10,269), respectively. Women aged 30-39 years at screening had higher rates of CIN2+ (include CIN2, CIN3 and cervical cancer). Our study indicates that VIA/VILI is a simple, feasible, and effective primary cervical cancer screening method in an impoverished, rural community that lacks access to standard medical care.