In low-resource settings, visual inspection screening method can reduce the incidence of cervical cancer

http://www.hindu.com/2007/08/05/stories/2007080554811200.
In low-resource settings, visual inspection screening method can reduce
the incidence of cervical cancer

Visual inspection seen to be effective in cervical cancer screening

Special Correspondent

Study conducted in Dindigul district, Tamil Nadu, finds it practical in
low-resource setting

CHENNAI: In low-resource settings, visual inspection screening method can
reduce the incidence of cervical cancer, Indian researchers have argued in
a paper published in The Lancet on August 4.

The study, described as ?the largest randomized controlled trial of visual
inspection screening for cervical lesions in a low-resource setting,? was
carried out in rural India from 2000 to the present. The visual inspection
screening method used in the study involves the application of acetic acid
on the cervix, followed by naked eye inspection of the area for white
colouration (indicative of pre-cancerous lesions). Over 30,000 women were
screened, against a similarly large control group, using the Dindigul
Ambillikai Cancer Registry (DACR) in Dindigul, Tamil Nadu, according to
the authors of the study. It was decided to base the study in Dindigul
district, India, because of the high risk of cervical cancer and the
availability of diagnostic and treatment facilities.

It was conducted as a collaborative effort with Cancer Institute (WIA),
Chennai, PSG Institute of Medical Sciences, Coimbatore, Dindigul district
administration and the Health department. The study was supported by a
grant from the Bill and Melinda Gates Foundation through the Alliance for
Cervical Cancer Prevention (ACCP), a group of five international
organisations with a shared goal of working to prevent cervical cancer in
developing countries.

Cervical cancer is the most common cancer in women in low-resource
countries. Eighty-five per cent of the global cervical cancer burden of
approximately 4,93,000 cases and 2,73,000 deaths have been reported from
developing countries, according to the study. It added: ?While new
vaccines have been launched to prevent infection by the two major types of
Human Papilloma Virus causing cervical cancer, prevention will need to
rely on early detection for a number of years before a sizeable reduction
in incidence and mortality is seen from affordable and efficient
immunization campaigns.?

The Papanicolaou test, or Pap Smear test, conventionally used to detect
cervical cancer and pre-cancerous lesions, could not be introduced in all
parts of the world, given that resources and logistics were not equal to
the task.

R. Sankaranayanan, principal author, said in the report: ?In low-resource
settings where cervix cancer is very common, we need a practical approach
to screening and early detection.? That is why it became important to
provide strong scientific evidence to validate the visual inspection
screening method, a cheaper and an easy-to-use alternative.

?The study shows a number of important findings with wide-ranging
implications,? the study quotes Peter Boyle, Director, International
Agency for Research on Cancer. India is one of the participating countries
in the IARC and Dr. V. Shanta, Chairman, Cancer Institute (WIA), Chennai,
is a member of the Scientific Council of the IARC.

?There is now evidence?that screening using visual inspection with 4 per
cent acetic acid (VIA), in the presence of effective treatment for the
lesions found, is effective in reducing incidence and mortality from
cervical cancer,? Dr. Boyle said.

Of the 31,000-odd women screened using VIA, 1,874 women were diagnosed
with pre-cancerous lesions and, 72 per cent were receiving treatment. A
total of 167 cervical cancer cases and 83 cervical cancer deaths were
observed compared with 158 cases and 92 deaths in the control group.
During this period, women receiving the VIA screening were 25 per cent
less likely to be diagnosed with cervical cancer and were 35 per cent less
likely to die from it as against those not being screened. These results
led to the conclusion that VIA screening, in the presence of good training
and sustained quality assurance, is an effective method for preventing
cervical cancer in developing countries.

?VIA offers a real-time advantage over other screening methods,
particularly in low-resource settings, with the distinct improvement of
diagnosis and rapid treatment at one go, meaning minimal dropouts. In
addition, a range of healthcare personnel can perform it, from the nurse
level up,? said Jacob Cherian, Director, Christian Fellowship Community
Health Centre, Ambillikai, India, one of the collaborators on the study.

Presenting the recommendations, P.O. Esmy, Principal Investigator at the
Centre, said, ?While prevailing conditions do differ dramatically between
low-resource nations, it is vital to set up organized screening programs
in the population, parallel to immunization programs, if we want to have a
significant impact on the incidence and mortality from this common
cancer.?


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