Abstract
In India, cervical cancer screening is conducted at various levels; however, after screening, the adherence to the cancer care continuum is barely understood. This study evaluated a community-based cancer screening program conducted in a rural setting (Tirunelveli and Tuticorin districts) in South India and reviewed the completion of care continuum. In this longitudinal descriptive study involving secondary data collection, data from the case records of 2192 women who were consecutively screened between March 2015 and May 2016 were included. All women underwent conventional cytology-based screening (Pap smear) and Visual Inspection with Acetic Acid (VIA). Those for whom either test was positive were referred for histopathological confirmation. Patients with confirmed precancerous conditions and unsatisfactory Pap smears were referred for further management. In total, 2192 women were screened [age range, 17–69 years; mean (standard deviation), 39.2 (8.5)]. Common symptom and sign were white discharge per vaginum (34.9%) and cervical erosion (34.4%), respectively. The VIA was positive for 24% (523/2178; 14 women did not cooperate for VIA) and 113 (5.1%) had epithelial cell abnormality in the Pap smear test. Per histopathology findings, one woman had non-keratinizing squamous cell carcinoma. Seven, three, and four had cervical intraepithelial neoplasia I, II and III, respectively. Of 2192, 807 were eligible for referral (597 had positive results on either Pap or VIA). Among the 807 women referred, only 74 (9.2%) women visited the referral center. The follow-up rate was very poor accounting to fragmentation of care continuum. The success of the screening program depends on the completion of the care continuum.
Highlights
India has the highest incidence of cervical cancer in Southeast Asia with approximately 132,000 new cases and 74,000 deaths annually [1,2]
The Visual Inspection with Acetic Acid (VIA) results were positive among 24% (523/2178; 14 women did not cooperate for VIA)
More than 50% (n = 8/14) of women with high-grade squamous intraepithelial lesion findings were positive on VIA
Summary
India has the highest incidence of cervical cancer in Southeast Asia with approximately 132,000 new cases and 74,000 deaths annually [1,2]. More than 80% of cervical cancer patients are diagnosed at advanced stages resulting in high mortality [3]. Cervical cancer is preventable owing to easy accessibility of the primary site, availability of simple and cost-effective screening methods, and its long preinvasive period. Even a single screening is effective in reducing the incidence and mortality of advanced cervical cancer [4]. The recommended screening tests are human papillomavirus test, cytology (Papanicolaou—Pap test), and unaided Visual Inspection with Acetic Acid (VIA). These are used as single tests or sequentially
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