Screening for cervical neoplasia in Bangladesh using visual inspection with acetic acid

Abstract

Objective To report the organization and early results of a visual inspection with acetic acid (VIA) screening program for cervical cancer prevention in Bangladesh. Methods Opportunistic VIA screening was offered by trained medical personnel to healthy women attending healthcare facilities in 44 districts. Colposcopy and/or directed biopsies were performed on VIA-positive women at Bangabandhu Sheikh Mujib Medical University (BSMMU) or medical college hospitals. The numbers of screened and VIA-positive women as well as the results of colposcopy, biopsy, and treatment of those with cervical intraepithelial neoplasia (CIN) attending BSMMU are reported. Results From January, 2005, to June, 2008, 104 098 women underwent VIA screening. Among them, 5013 (4.8%) women were positive, of whom 4371 (87.2%) attended colposcopy clinics in different hospitals. Of the 2188 who underwent colposcopy at BSMMU, 157 were diagnosed with CIN 2–3 and 123 with invasive cancer. For 2065 women (excluding the cancer cases), results for sensitivity, specificity, and positive predictive value of VIA to detect CIN 2–3 lesions were 93.6%, 58.3%, and 15.6%, respectively. Almost half the women with CIN 2 or 3 lesions had treatment. Conclusion A VIA-based program would facilitate the development of screening, diagnosis, and treatment of cervical neoplasia and improve awareness of cervical cancer prevention in Bangladesh.