Cervical Cancer Screening Using Visual Inspection after Application of 5% Acetic Acid (VIA) in Rural West Bengal

ABSTRACT Background Because of problem of manpower in developing countries, cytology screening for cervical cancer is gradually replaced by a Visual Inspection after application of 5% acetic acid (VIA) with triage of colposcopy. Objectives Hence, government and other funding bodies in India are now eager to see its efficacy in the field to screen and manage cervical pre cancer (CIN) in a “see & treat” approach. Methods This simple technology combined with colposcopy is planned in a biotechnology based programme for women under Department of Biotechnology, Govt. of India where efficacy of VIA was assessed by camp approach in rural area of a remote district (Burdwan) of West Bengal province in India from August 2010 to August 2011. We used video colposcopy as triage and managed positive cases by Loop Electrosurgical Excision Procedure (LEEP). We evaluated our early screening and management results by finding out detection rates of early lesions of cervix and in this uncontrolled observational study. Results A total of 2836 women participated in our rural camp for screening during this period. Amongst them 2354women could be subjected to visual inspection by acetic acid (VIA) using 200 watt bulb and 5% acetic acid by the trainedcommunity nurse. We could not do VIA in 482 subjects because of no consent-22.80%, non-cooperation-23.40%, unmarried-18.60%, menstruating-12.80%, pregnant-10.50%, hysterectomised-9.10% and cervix cancer neglected or infollow up-2.50%. We could detect 415 cases of VIA positive cases showing white lesion in their cervix. Colposcopic prediction of cervical Intra-epithelial neoplasia grade I(CIN I) lesion could be detected in 174 cases. These cases are of no immediate risk and most of them actually showregression of their disease. Hence, they are advised to have follow-up colposcopy after six months. There were 25 cases of condyloma/ polyp. They were managed by electro- cautery. We could detect and treat 33 cases of CIN II andIII which are precursor of cervical cancer. They were treated by LEEP. Conclusion Our results show that VIA with colposcopy triage is viable option in rural cervical cancer screening programme in our outreach program. Disclosure All authors have declared no conflicts of interest.