Cervical Cancer Screening by Simple Visual Inspection After Acetic Acid

Abstract

Cervical cancer kills almost 250,000 women each year in developing countries, representing more than 80% of the worldwide deaths due to this preventable cancer. Almost all cases of cervical dysplasia or cervical cancer are caused by Human Papilloma Virus (HPV), which is spread through sexual contact. Three main factors have been postulated to influence the progression of low-grade cervical dysplasia lo high-grade lesion and cervical cancer. These include the type and duration of viral infection; host conditions that compromise immunity, such as multiparity or poor nutritional status and environmental factors such as smoking, oral contraceptive pill use or vitamin deficiencies. In addition, various gynecologic factors, including early age of first intercourse and number of sexual partners significantly increase the risk for cervical cancer. Cervical cytology has been success in the developed world in reducing the incidence and mortality of cervical cancer. But in most developing countries, despite decades of effort, cytology-based cervical cancer prevention programs have not been successful for several different reasons like inadequate coverage of a large population, specially the rural and underdeveloped sections of society, lack of adequate infrastructure, including medical and paramedical staff, laboratory and transport facilities, and trained cytotechnicians and cytopathologists, poor compliance with follow-up visits and the low sensitivity of the Pap smear resulting in a high false-negative rate of 9 to 40%. The sensitivity of the Pap smear has been found to be even lower in developing countries. The possible reason for this may be the large percentage of cervicitis and inflammatory smears, which mask mi Id dysplasia. Because or the burden of cervical cancer is the highest in such low-resource settings, clinicians in developed countries began to explore alternative methods that meet all the basic criteria of a good screening test (e.g. effective, available, affordable, safe and practical) ………………………………