The Government of Tamil Nadu in India, has embarked on a programme of implementing an effective, but cost-friendly procedure to detect pre-cancerous changes in the cervix of rural women. This programme is earmarked to be executed in the Southern districts of Thanjavur and Theni.
Cervical cancer is the leading cancer among the women in the developing countries where an estimated 300,000-500,000 thousand women succumb to it every year. This malignancy is prevalent among rural women and putting the Visual Inspection With Acetic acid (VIA) method into effect is lauded as a significant move.
Advertisement'The Lancet' had promoted the VIA as a classic method for cervical cancer detection among rural women based on a randomized controlled trial study in the economically -challenged settings of Ambillikai in the Dindigul district of Tamil Nadu. The success index in Theni and Thanjavur will be the determining factor for a wider implementation of the programme.
Visual Inspection With Acetic acid is a quick method that efficiently picks up precancerous and cancerous lesions in the cervix. A combination of simplicity and cost factor has made VIA an ideal method for cervical cancer detection. Some of the other salient features include:
• VIA does not require extensive training or any special equipment.
• The entire procedure costs a meagre Rs.30.
• If the lesion so detected is pre-malignant, a simple cryosurgery can be included for treatment and the cost in India would be Rs.100.
• In comparision to VIA, the gold standard test for detecting cancer of the cervix, called the Pap smear, costs about Rs. 200.
• VIA is more effective in detecting precancerous lesions than Pap smears.
• Sensitivity of the method is equal to or better than that of Pap smear. Specificity, though, is lower.
• The woman is made to lie down on her back with legs bent at the knees (lithotomy position)
• The source of light is focused on to the genital area in order to get optimum visualization
• Changes in the external genital area are recorded
• The speculum is lubricated with warm water
• The speculum is closed before being inserted into the vagina
• After insertion, the speculum is opened and the light source adjusted to provide a clear view of the cervix
• Excess mucus is removed using a saline swab
• The cervix is surveyed for abnormal changes
• It is then washed with 3-4% acetic acid using a syringe
• After a minute's pause, the cervix is inspected again for abnormal changes
This procedure is not carried out during menstruation or while on intravaginal medications.
If precancerous or cancerous lesions are present, they turn white on encountering acetic acid. In case of an abnormal cancerous lesion, the patient needs to be referred to a tertiary care center. A precancerous lesion, however, may be managed through cryo surgery. This is performed by using an instrument to freeze the outer abnormal cells of the cervix.
Experts have forewarned that the programme has to be put into practice efficiently and correctly, right from the word 'go'. In developing countries, where early marriage is the norm, the task of educating the masses about the need for screening must be undertaken diligently.
It is an immediate necessity to educate the nursing assistants about the procedure and to train the doctors and nurses to treat precancerous cervical lesions. It must be noted that cytological studies, such as the Pap smear, are expensive in countries where the health care infrastructure is compromised.
Cheap methods of cancer surveillance, such as the Visual Inspection through Acetic acid, promotes the health and well-being of individuals in the developing countries with a huge rural population, such as India, and also of those in the poorer nations of the world.
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