Visual inspection using acetic acid for cervical cancer in low resource settings

Abstract

Cervical cancer is a major public health problem in developing countries, with India itself accounting for one-fifth of the global burden of the disease. Approximately 1,30,000 new cases of cervical cancer are being detected in the country each year. India's cervical cancer age-standardised incidence rate of 30.7 per 100,000 and age-standardised mortality rate of 17.4 per 100,000 are the highest in South Central Asia [1]. While the ultimate option for reducing the prevalence of cervical cancer is vaccination, the costs are prohibitive. Though cytology (Pap smear) is reliable, the laboratory infrastructure and logistics including technical expertise may not be available in low-resource countries. The cost factor in testing for human papillomavirus (HPV) using DNA testing, coupled with requirement of trained manpower makes this option non-viable for developing countries [2], thus accentuating the need for alternative screening procedures. Visual inspection using acetic acid (VIA) has emerged as a promising, cost effective, non-cytology based, “see and treat” alternative for economically underprivileged geographic regions [3].