The naked-eye visual inspection of the uterine cervix after applying acetic acid (VIA) or Lugol's iodine (VILI) is a cost-effective and feasible alternative to Pap smear for early detection of cervical precancerous lesions and early invasive cancer, says Dr R Sankaranarayanan, Head, Screening Group, International Agency for Research on Cancer (IARC) of the World Health Organisation (WHO).
Recently on a visit to India, the expert told Medindia that a sustained campaign was necessary to promote these options, which had been used in the country in the past too till the advent of the Pap smear.
VIA or VILI costs less than Rs 50 per patient when compared to Rs 250-500 for the smear test.
Pap smear, the currently popular test to detect cervical cancer, requires some elaborate infrastructure and specially trained technicians. But the VIA and VILI are far simpler.
Explaining the tests, Sankaranarayanan, said the precancerous lesion would turn white when 3-5 percent of acetic acid (VIA) was applied over it. If it was early cancer stage, the spot would turn intensely white. On the other hand, when you apply dilute iodine, the spot would turn yellow. Any person with a medical background can do these tests. Even those who passed out of school could be trained for the purpose. he said
The VIA and VILI virtually disappeared with the arrival of Pap smear in the 1940's, but lately interest has revived in it. Currently the tests are used in research settings in places like India, Sub-Saharan African countries and Thailand
``Out of the six lakh women screened by us in these countries, four lakh were screened through visual inspections and the results are very encouraging,'' Dr Sankaranarayanan said.
The organisations involved in the evaluation of these tests include IARC, other organs of WHO and in India, Indian Council of Medical Research. The Bill and Melinda Gates Foundation had extended financial support through Alliance for Cervical Cancer Prevention.
Poor nutrition, living conditions, education and hygiene are among the factors that contribute to cervical cancer.
India has the largest incidence for cervical cancer in the world. Twenty-five percent of the world's cervical cancer cases occur in India, Dr Sankaranarayanan said.
As there is no government sponsored screening programme in India, as of now, most of the cervical cancer cases are detected at an advanced stage when cure becomes impossible.
"It is important that countries like India invests in screening programmes like VIA and VILI. Women in the age group of 30-49 years should have at least a single life time test to begin with, Dr Sankaranarayanan stressed.
The Indian Government has incorporated these tests in the National Cancer Control Programme while the Tamil Nadu State government has major plan to introduce it as part of its cancer control programme.
"It requires large number of people and training to translate this policy into action. The WHO will play a catalyzing role, but it is the governments concerned that can execute the scheme on the ground," Sankaranarayanan noted.