Abstract
Objectives:We are reporting the evaluation of an opportunistic point of care cervical cancer screening initiative in Pune, India using a mobile screening unit (MSU). Methods:We conducted 290 cervical cancer screening outreach clinics in the MSU. Screening was performed by trained nurses/ health care providers using visual inspection with 5% acetic acid (VIA). Screen positive women when eligible were treated by thermal ablation during the same sitting. Women with large lesions not eligible for treatment with thermal ablation were referred for colposcopy and treatment. Results: A total of 10, 925 women were screened between Nov 2016 and June 2019 in 290 outreach clinics in the MSU. The overall screen positivity was 6.6% (95% CI 6.1, 7.0) with a declining trend over time. A total of 304/717 (42.4%, 95% CI 38.7, 46.1) women received treatment with thermal ablation. About 3.6% (11/304) reported minor side effects and 1.6% (5/304) reported lower abdominal pain and all of them subsided after treatment. Among the 413 women who were advised colposcopy, only 84 (20.33%) women underwent the procedure. Of these 84 women, 64 (76.19%) had normal colposcopy/ histopathology, 7 (8.33%) had CIN1, 2 (2.38%) had CIN 2, 9 (10.71%) had CIN 3 disease and 2 (2.38%) women were diagnosed with invasive cancer. Conclusion:MSUs are useful for providing cervical cancer screening services, using the ‘screen and treat’ strategy. Thermal ablation is safe in the field clinics. Additional efforts are needed to improve the compliance for referral of those with large lesions requiring additional visits.
Highlights
Cervical cancer is the fourth most common cancer among women (Arbyn et al, 2020)
None of the screening clinics were cancelled on the day of the clinic, sometimes they had to be postponed and participation rates were sometimes affected by heavy rainfall or cultural issues such as festivals
Except for one outreach clinic when the gloves had to be purchased from a nearby medical facility, our team did not face any problems with the supplies
Summary
Cervical cancer is the fourth most common cancer among women (Arbyn et al, 2020). In 2018, the age-standardised incidence of cervical cancer was 13.1 per 100 000 women globally (Arbyn et al, 2020). India accounts to about a fifth of the global burden of cervical cancer and has contributed 97 000 cases and 60 000 deaths in 2018 (Arbyn et al, 2020). Screening and vaccination are two powerful tools that are currently available for preventing cervical cancer and have the potential to practically eliminate cervical cancer. Vaccination of adolescent girls is very promising especially in the countries that do not have screening programs in place
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