Study to assess the acceptability and feasibility of cervical cancer screening using visual inspection with acetic acid and treatment of precancerous lesions using cryotherapy in low resource settings
Keywords:
Secondary prevention, Cervical cancer, Colposcopy, CryotherapyAbstract
Background: Objective of current study was to assess the acceptability and feasibility of cervical cancer screening using VIA, and treatment of precancerous lesions using cryotherapy in low resource settings
Methods: 526 women from three primary health centers of Shinor taluka (population based approach) and 250 women of Medical College, Vadodara (facility based approach) were sensitized and screened for cervical cancer. Visual Inspection with Acetic acid (VIA) was performed as the screening test. In the population based approach, VIA positive women were referred to a Community Health Centre (CHC) for colposcopy and biopsy. Ablative treatment in the form of cryotherapy was offered. Patients requiring higher forms of treatment were referred to medical college, Vadodara. In the facility based approach, VIA positive women underwent colposcopy. Guided biopsy was performed in those with positive lesions on colposcopy. Cryotherapy was offered in the same sitting. Those not suitable for cryotherapy were offered loop electrosurgical excision procedure. Women found to have invasive cancer were offered definitive management.
Results: VIA positivity rate was 18.8% in the population based approach and 27.2% in the facility based approach.58.8% women in the population based approach and 77.77% women in the facility based approach were treated with cryotherapy on the same day as screening and none reported any severe side effects. Dropout rate in the community approach was 32.32% whereas in the facility it was 0.4%.
Conclusions: VIA and cryotherapy procedures were well tolerated by all screened women. This project has shown that the “screen and treat” approach can be successfully implemented in the existing health setup.
References
Kitando H. Cancer of the cervix: knowledge and attitudes of female patients admitted at Muhimbili National Hospital, Dar es Salaam. East Afr Med J. 2002;79:467-75.
Bingham A. Factors affecting utilization of cervical cancer prevention services in low resource settings. Salud Publica de Mexico. 2003;45(Suppl 3):S408-16.
Herdman C. Planning appropriate cervical cancer prevention programs. In: Herdman C, eds. Program for Appropriate Technology in Health (PATH). 2nd ed. Seattle, WA, USA: PATH; 2000: 1-89.
Miller A. Cervical cancer screening programmes: managerial guidelines. In: Miller A, eds. WHO Guideline. Geneva: World Health Organization; 1992: 1-50.
Blumenthal P et al. Evaluation of supply and demand factors affecting cervical cancer prevention services. In: Blumenthal P et al., eds. Rio Et Province, Thailand. Baltimore: Jhpiego; 2004: 1-20.
Goldie S et al. Policy analysis of cervical cancer screening strategies in low-resource setting. J Am Med Assoc. 2001;285:3107-15.
Gaffikin L et al. Visual inspection with acetic acid as a cervical cancer test: accuracy validated using latent class analysis. BMC Med Res Methodol. 2007;7:36.
Sankaranarayanan R et al. Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster randomised trial. Lancet. 2007;370:398-406.
Blumenthal P et al. Safety, acceptability, and feasibility of a single-visit approach to cervical cancer prevention in rural Thailand: a demonstration project. In: Blumenthal P et al., eds. Rio Et Province, Thailand. Baltimore: Jhpiego; 2003: 1-44.
Blumenthal P et al. A qualitative evaluation of the acceptability and feasibility of a single visit approach to cervical cancer prevention. In: Blumenthal P et al., eds. Rio Et Province, Thailand. Baltimore: Jhpiego; 2004: 1-33.
Adadevoh S et al. A qualitative evaluation of the acceptability and feasibility of a single visit approach to cervical cancer prevention in Ghana. In: Adadevoh S et al., eds. Ghana Group. Baltimore: Jhpiego; 2004: 1-23.
Sellors J et al. Screening and management of precancerous lesions to prevent cervical cancer in low resource settings. Asian Pac J Cancer Prev. 2003;4:277-80.
Sankaranarayanan R et al. Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster randomised trial. Lancet. 2007;370:365-6.
Olatunbosun O. Outcome of cryotherapy for cervical intraepithelial neoplasia in a developing country. Int J Gynecol Obstet. 1992;38:305-10.
Chirenje ZM et al. A randomised trial of loop electrosurgical excision procedure (LEEP) versus cryotherapy in the treatment of cervical cancer intraepithelial neoplasia. J Obstet Gynecol. 2001;21:617-21.
Denny L et al. Screen-and-treat approaches for cervical cancer prevention in low-resource settings: a randomized controlled trial. J Am Med Assoc. 2005;294:2173-81.
Blumenthal PD, McIntosh N. Cervical cancer prevention guidelines for low-resource settings. In: Blumenthal PD, McIntosh N, eds. A Guideline. Baltimore: Jhpiego; 2005: 1-1-H-3.
National Cancer Control Programme. Guidelines for cervical cancer screening programme. In: NCCP, eds. Government of India. World Health Organisation Collaborative Programme, 2004-2005. Chandigarh, India: NCCP; 2006: 1-35.
Sankaranaryanan R, Basu P, Wesley RS et al. Accuracy of visual screening for cervical neoplasia: results of an IARC Multicentre trial in India and Africa. Int J Cancer. 2004;110:907-13.
