Cervical screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy in Fiji.

James Fong,Richard Taylor,Catherine Mcgowan,Rajaneshwar Gyaneshwar,Stephen Morrell,Anne Stuart,Ann Brassil,Sophia Lin

doi:10.7314/apjcp.2014.15.24.10757

Abstract

The purpose of this study was to demonstrate the feasibility of VIA screening with cryotherapy and to record normative values for indicators anticipated in similar low resource settings. Women aged 30-49 years were targeted, resulting in 1961 women screened and treated at two primary health care (PHC) centres near Suva, Fiji. Recruitment was through provision of information, education and communication (IEC). Referrals to a gynaecology outpatient department (OPD) at a referral hospital occurred throughout the screening pathway. Participation was 32% (95%CI 31-33%), higher in iTaukei (Melanesians) women (34%, 95%CI 33-36) compared to Fijians of Indian descent (26%, 95%CI 24-28). Regression analysis, adjusted for confounders, indicated significantly lower participation in those of Indian descent, and age groups 35-39 and 45-49 years. Of those examined by VIA, 190 were positive with aceto-white lesions (9.9%), within the expected range of 8-15%, with minor geographic and ethnic variation. Positive VIA results were more common in the peri-urban area, and in those aged 35-39 years. Of women aged 30-49 years, 59 received cryotherapy (none of whom had significant complications), 91 were referred to OPD, two cervical carcinomas were identified and eight cervical intra-epithelial neoplasms (CIN) II-III were diagnosed. These results provide normative findings from a community-based VIA screening program for other similar low resource settings.

Highlights

Cervical cancer has a high disease burden (Arbyn et al, 2008)
The purpose of this study is to demonstrate the feasibility of Visual Inspection with Acetic acid (VIA) screening with cryotherapy and to document normative outcomes and data to be expected in similar low resource settings
This study has demonstrated that it is feasible to train nurses and doctors for VIA and cryotherapy at primary health care (PHC) level in Fiji, with continued supervision and clinical audit

Summary

Introduction

Fiji has one of the highest incidences of cervical cancer in the Pacific region (Kuehn et al, 2012; Foliaki et al, 2011). Organised population-wide Pap test screening has led to decreases in incidence and mortality from cervical cancer in the years following screening introduction. In New South Wales, Australia, a sustained decrease in cervical cancer incidence commenced immediately after introduction of organised screening, and mortality began to decline three years later (Taylor et al, 2006). In Scandinavia, cervical cancer mortality reduction commenced three years after implementation of an organised cervical screening program (Laara et al, 1987; Sigurdsson, 1999). WHO has recently issued a recommendation to employ a screen-and-treat approach using Visual Inspection with Acetic acid (VIA) for screening, and treatment with cryotherapy (WHO, 2013)

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Conclusion