Prevention and Control of Cervical Cancer by WHO-Endorsed Guidelines for Visual Inspection with Acetic Acid (Via) as a Simple Screening Method: Prevention and Control of Cervical Cancer

Sania Ratyal; Shazia Saeed; Nasreen Hameed; Sara Akram; Maryam Sabir Khan; Ayesha Fatima

doi:10.54393/pjhs.v5i12.2494

Authors

Sania Ratyal Department of Gynecology and Obstetrics, Divisional Headquarter Teaching Hospital, Mirpur, Pakistan
Shazia Saeed Department of Gynecology and Obstetrics, Divisional Headquarter Teaching Hospital, Mirpur, Pakistan
Nasreen Hameed Department of Gynecology and Obstetrics, Divisional Headquarter Teaching Hospital, Mirpur, Pakistan
Sara Akram Department of Gynecology and Obstetrics, Divisional Headquarter Teaching Hospital, Mirpur, Pakistan
Maryam Sabir Khan Department of Gynecology and Obstetrics, Divisional Headquarter Teaching Hospital, Mirpur, Pakistan
Ayesha Fatima Department of Gynecology and Obstetrics, Divisional Headquarter Teaching Hospital, Mirpur, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i12.2494

Keywords:

Cervical Cancer, Acetic Acid, Diagnostic Accuracy, Visual Inspection

Abstract

Despite the availability of primary prevention through Human Papillomavirus (HPV) vaccination, cervical cancer remains one of the leading causes of cancer-related deaths among women worldwide. And imposes an enormous global public health burden most notably for those living in low- or middle-income countries. Objective: To determine the diagnostic accuracy of VIA in diagnosing cervical cancer as compared to conventional methods. Methods: This retrospective study analyzed a cohort of women who underwent VIA screening for cervical cancer at Divisional Headquarters Teaching Hospital. The sample included 1,200 women aged 25-65 who had not been screened for cervical cancer in the previous three years. VIA screening followed WHO-recommended procedures, with presumptive diagnoses made through naked eye examination based on WHO guidelines for low-resource settings. Data was entered and analyzed by SPSS 25.0. Results: Among 1,200 women screened for cervical abnormalities using VIA, 280 tested positive (23.3%). The highest VIA-positive rates were in the 45-54 age group (112 positives), followed by the 35-44 group (70 positives). The diagnostic accuracy of VIA for cervical abnormalities shows high sensitivity (89.34%) and specificity (96.23%). VIA's positive predictive value was 85.83%, while the negative predictive value was 97.25%, indicating reliable detection of true positives and negatives. Conclusions: VIA was an accurate, affordable screening tool with a high level of sensitivity and specificity in detecting cervical precancerous lesions, particularly for low-resource settings. These results highlight the effectiveness of VIA screening across age groups, with higher detection rates in women over 35.

References

Hull R, Mbele M, Makhafola T, Hicks C, Wang SM, Reis RM, Mehrotra R, Mkhize‑Kwitshana Z, Kibiki G, Bates DO, Dlamini Z. Cervical cancer in low and middle‑income countries. Oncology letters. 2020 Sep 1;20(3):2058-74.

Parham GP, Mwanahamuntu MH, Kapambwe S, Muwonge R, Bateman AC, Blevins M et al. Population-level scale-up of cervical cancer prevention services in a low-resource setting: development, implementation, and evaluation of the cervical cancer prevention program in Zambia. PLOS One. 2015 Apr; 10(4): e0122169. doi: 10.1371/journal.pone.0122169.

Awan UA and Khattak AA. Has Pakistan failed to roll back HPV?. The Lancet Oncology. 2022 May; 23(5): e204. doi: 10.1016/S1470-2045(22)00141-3.

Chughtai N, Perveen K, Gillani SR, Abbas A, Chunara R, Manji AA, Karani S, Noorali AA, Zakaria M, Shamsi U, Chishti U. National cervical cancer burden estimation through systematic review and analysis of publicly available data in Pakistan. BMC public health. 2023 May 5;23(1):834.

Wright Jr TC and Kuhn L. Alternative approaches to cervical cancer screening for developing countries. Best Practice & Research Clinical Obstetrics & Gynaecology. 2012 Apr; 26(2): 197-208. doi: 10.1016/j.bpobgyn.2011.11.004.

World Health Organization. Strategic framework for the comprehensive prevention and control of cervical cancer in the Western Pacific Region 2023-2030.

Denny L, Saidu R, Boa R, Mbatani N, Castor D, Moodley J et al. Point-of-care testing with Xpert HPV for single-visit, screen-and-treat for cervical cancer prevention: a demonstration study in South Africa. Scientific Reports. 2023 Sep; 13(1): 16182. doi: 10.1038/s41598-023-43467-2.

Poli UR, Bidinger PD, Gowrishankar S. Visual inspection with acetic acid (via) screening program: 7 years experience in early detection of cervical cancer and pre-cancers in rural South India. Indian Journal of Community Medicine. 2015 Jul; 40(3): 203-7. doi: 10.4103/0970-0218.158873.

Mustafa MS, Jindal AK, Singh PM. Visual inspection using acetic acid for cervical cancer in low resource settings. Medical Journal Armed Forces India. 2010 Oct 1;66(4):382-4.

Laxmi M, Reddy SS. Cervical Cancer Screening by Simple Visual Inspection After Acetic Acid. International journal of health sciences.;6(S4):9371-8.

Rajpar SA, Memon FA, Munawar RA. Visual Inspection of the Cervix with Acetic Acid for Screening of Cervical Cancers. Pak J Med Health Sci. 2021;15(1):516-9.

Sankaranarayanan R, Wesley RS, World Health Organization. A practical manual on visual screening for cervical neoplasia. 2003.

Chamot E, Kristensen S, Stringer JS, Mwanahamuntu MH. Are treatments for cervical precancerous lesions in less-developed countries safe enough to promote scaling-up of cervical screening programs? A Systematic Review. BioMed Central Women's Health. 2010 Dec; 10: 1-1. doi: 10.1186/1472-6874-10-11.

Rajaram S and Gupta B. Screening for cervical cancer: Choices & dilemmas. Indian Journal of Medical Research. 2021 Aug; 154(2): 210-20. doi: 10.4103/ijmr.IJMR_857_20.

Taha T, Yousuf S, Rehmani D. Direct Visual Inspection with Acetic Acid: A Cost-Effective Test for Cervical Cancer Screening. Pakistan Journal of Medicine and Dentistry. 2021 Apr-Jun; 10(2): 36-42. doi: 10.36283/PJMD10-2/007.

Cubie HA, Campbell C. Cervical cancer screening–the challenges of complete pathways of care in low-income countries: focus on Malawi. Women's Health. 2020 May;16:1745506520914804.

World Health Organization. New recommendations for screening and treatment to prevent cervical cancer.(2021) [Internet]. 2023

Vinals R, Jonnalagedda M, Petignat P, Thiran JP, Vassilakos P. Artificial intelligence-based cervical cancer screening on images taken during visual inspection with acetic acid: A systematic review. Diagnostics. 2023 Feb; 13(5): 836. doi: 10.3390/diagnostics13050836.

Malabadi RB, Sadiya MR, Prathima TC, Kolkar KP, Mammadova SS, Chalannavar RK. Cannabis sativa: Cervical cancer treatment-Role of phytocannabinoids-A story of concern. World Journal of Biology Pharmacy and Health Sciences. 2024 Feb; 17(2): 253-96. doi: 10.30574/wjbphs.2024.17.2.0076.

Shastri SS, Mittra I, Mishra G, Gupta S, Dikshit R, Badwe RA. Effect of visual inspection with acetic acid (VIA) screening by primary health workers on cervical cancer mortality: A cluster randomized controlled trial in Mumbai, India. 2014 Feb; 106(3): dju009. doi: 10.1093/jnci/dju009.

Adnan Z, Khan AA, Nayyar S, Nayyar A, Anwar Z, Ahsan S. Diagnostic Accuracy of Visual Inspection with Acetic Acid (VIA) and PAP Smear in Diagnosing Cervical Cancer, Taking Histopathology as Gold Standard. Journal of the Society of Obstetricians and Gynaecologists of Pakistan. 2021 Apr; 11(1): 36-40.

Huy NV, Tram NV, Thuan DC, Vinh TQ, Thanh CN, Chuang L. The value of visual inspection with acetic acid and Pap smear in cervical cancer screening program in low resource settings-A population-based study. Gynecologic Oncology Reports. 2018 May; 24: 18-20. doi: 10.1016/j.gore.2018.02.004.

Ameena L. Comparative Study of Pap Smear Verses Visual Inspection with Acetic Acid in Screening for Cervical Cancer. Indian Journal of Public Health Research & Development. 2021 May; 12(3): 106-14. doi: 10.37506/ijphrd.v12i3.16050.