Visual Inspection With Lugol's Iodine Research Articles

Cervical Cancer Visual Screening Experience in the Republic of Tajikistan

OBJECTIVES: To study the results of the first pilot study of organized visual cervical cancer (CC) screening for the detection of precancerous pathology of the cervix in two pilot districts of the Republic of Tajikistan. STUDY DESIGN: In this cross-sectional study, the target group included healthy women of reproductive age (30-49 years) from Kushoniyon and B. Gafurov Districts who underwent visual screening. The total study population was 72,574 out of which 68,391 (94.3%) visited primary healthcare facilities for visual inspection with Lugol’s Iodine (VILI). A total of 2958 women with suspicious tests for cervical intraepithelial neoplasia (CIN) were identified (4.3%) and sent to the reproductive health care centers for further diagnostics. Post-screening diagnostic tests were performed to specify cervical lesions, which included colposcopy with acetic acid (VIA) visual inspection, cytology, and biopsy with histological examination. HPV testing wasn’t included in the diagnostic protocol due to its high cost. RESULTS: A total of 164 histologically confirmed cases of CIN were identified (0.25% of number of women screened). The detection rate of precancerous pathology was 26.9 per 100,000 female population, which is 8.2 times higher than the detection rate of CC. All patients regardless of CIN degree underwent loop electrosurgical excision (LEEP)/conization. In the follow-up period (6-48 months), complete recovery after 136 LEEP, 21 conizations, and 7 hysterectomies were observed in 97% (5 recurrences of non-invasive disease). CONCLUSION: The visual screening showed high efficiency in detecting CIN. The positive experience suggests the implementation of this program nationwide.

Abstract 821: Uptake of cervical cancer screening services by women living with HIV in Kajiado County Kenya

Abstract Background: This project is an African Caribbean Cancer Consortium (AC3) facilitated study: Women living with HIV (WLHIV) are more susceptible to cancer due to their immune-compromised status. The Kenya Ministry of Health recommends that women diagnosed with HIV should be screened for cervical cancer annually by either visual inspection with acetic acid (VIA) or visual inspection with Lugol’s iodine (VILI), cytology and testing for HPV once every two years. Objective: We determined the uptake of cervical cancer screening and HPV testing by women living with HIV (WLHIV) in Kajiado County in 2022. Methodology: The electronic health information system was used to abstract data for WLHIV in Kajiado county. Kajiado county has 57 antiretroviral (ART) facilities. However, our analysis accessed data from 38 facilities whose data is captured in the health information system. Authorized health care workers from the county were requested to abstract redacted data from the health information system. No personal identifiers were collected from the system as a means of protecting the privacy of individuals and abiding with the Kenya’s data protection law. Authorization to access the county was obtained from the county’s department of health while ethical approval was obtained from Mount Kenya University’s Institutional Scientific and Ethics Review Committee. Results: A total of 16,827 people living with HIV were enrolled for care at the 38 ART selected sites in 2022. Out on the total population that was enrolled for care, 11,785 (70%) were women with an age range of 15 to 49 years. A total of 3342 WLHIV, representing 28.36% of the target population, were screened by using visual inspection with acetic acid (VIA). Data for other methods of screening and HPV testing was not available in the health information systems. Of those screened, 3240 (97%) tested negative, 78 (2.3%) had positive results while 24 (0.7%) had suspicious lesions. Conclusion: Our analysis shows low uptake of cervical cancer screening services with only 28.36% of the targeted women being screened in 2022. The only available testing method (VIA) is less robust as compared to cytology and HPV testing. We also found a gap in reporting of HPV testing in the county. We thus recommend implementation science research examining the systemic barriers to HPV testing and reporting to better inform best practice HPV-related cancer prevention and control policy and practice to reduce cancer-related morbidity and mortality among WLHIV. Citation Format: Caren Kamau, Alice Njoroge, Francis Makokha, Kimlin T. Ashing. Uptake of cervical cancer screening services by women living with HIV in Kajiado County Kenya [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 821.

Effects of 5-aminolevulinic acid photodynamic therapy for cervical low-grade squamous intraepithelial lesions with HR-HPV infections.

To determine the effectiveness and safety of 5-aminolevulinic acid mediated photodynamic therapy (5-ALA PDT) in HR-HPV infected patients with cervical low-grade squamous intraepithelial lesions (LSIL) and to explore possible factors affecting treatment outcomes. This retrospective study included 96 patients with histologically confirmed cervical LSIL and high-risk human papillomavirus (HR-HPV) infection. They received 5-ALA PDT treatment once a week for a total of 3 courses. All patients were evaluated by cytology tests, HPV DNA assay, colposcopy, and biopsy at 2 weeks, 3 months, and 6 months checkpoint. The chi-square test were used to evaluate the differences in various clinical data, and a p value <0.05 was considered statistically significant. At 2 weeks, 3 months, and 6 months checkpoint, colposcopies showed that the cervical iodine-unstained area under VILI (visual inspection with Lugol's iodine) significantly reduced (p < 0.01) with no structure changes. At 3 months and 6 months checkpoint, the pathological regression rate reached 87.5% (84/96) and 94.79% (91/96), while the HR-HPV clearance rates reached 80.21% (77/96) and 93.75% (90/96) respectively. We also examined the efficacy in the HPV 16/18-related group and non-HPV 16/18-related group. The HR-HPV clearance rate in the HPV16/18 group [94.87% (37/39)] was significantly higher than that of the non-HPV 16/18 group [70.17% (40/57)]. However, at 6 months after treatment, the clearance rate of the HPV 16/18 group [94.87% (37/39)] showed no statistical difference from the non-HPV 16/18 group [92.30% (53/57)]. Topical 5-ALA PDT can effectively eliminate HR-HPV infection and treat low-grade cervical squamous intraepithelial lesions, it offers an alternative treatment option for patients with LSIL, especially for those with fertility requirements and who wish to preserve cervical structure or function.

Performance of screening tools for cervical neoplasia among women in low- and middle-income countries: A systematic review and meta-analysis.

To evaluate the performance of visual inspection with acetic acid (VIA) testing, visual inspection with Lugol's iodine (VILI), primary HPV testing, and conventional Pap smear in detecting CIN2+ among non-pregnant women aged 30-65 in LMICs between 1990 and 2020. Systematic review and meta-analysis. Low- and middle-income countries, non-pregnant women aged 30-65. CENTRAL (Cochrane Library), CINAHL, Embase, Global Health, PubMed, and Web of Science databases were systematically searched to identify studies evaluating the performance of cervical cancer screening methods in LMICs. A diagnostic test accuracy meta-analysis was conducted to evaluate the performance of 4 screening methods in detecting CIN2+ relative to biopsy or cytology reference standards. Pooled statistics for sensitivity, specificity, diagnostic odds ratios, and summary receiver operating characteristic curves were determined for each method. Subgroup analyses were performed to examine whether there was variation in performance based on different reference standards for defining CIN2+, specifically: colposcopy-directed biopsy, biopsy alone, colposcopy alone, or liquid-based cytology. Eighteen studies were identified through systematic review. Twelve studies were included in meta-analysis; 11 were cross-sectional and 1 was a randomized controlled clinical trial. The remaining six of the eighteen studies were inclided in a narrative syntehsis. Pooled estimates for sensitivity for VIA, VILI, primary HPV testing, and conventional Pap smear were 72.3%, 64.5%, 79.5%, and 60.2%, respectively; pooled estimates for specificity were 74.5%, 68.5%, 72.6%, and 97.4%, respectively; the diagnostic odds ratios were 7.31, 3.73, 10.42, 69.48, respectively; and the area under the summary receiver operating characteristic curves were 0.766, 0.647, 0.959, and 0.818, respectively. Performance of the screening method varied based on the reference standard used; pooled estimates using either colposcopy-directed biopsy or biopsy alone as the reference standard generally reported lower estimates; pooled estimates using either colposcopy alone or liquid-based cytology as references reported higher estimates. This meta-analysis found primary HPV testing to be the highest performing cervical cancer screening method in accurately identifying or excluding CIN2+. Further evaluation of performance at different CIN thresholds is warranted.

Evaluation of multiple screening methods for cervical cancers in rural areas of Xinjiang, China.

This study is to evaluate the screening methods of cervical cancers for rural females in Kash bachu, Xinjiang, China.A total number of 3000 married females were surveyed, and subjected to the gynecological examination. In these subjects, 1993 females received the careHPV (human papillomavirus) test, while 1007 females underwent the visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI). The subjects positive for careHPV detection were subjected to Cervista, Cobas 4800, and Aptima HPV detection, and Thinprep Cytologic Test (TCT). The subjects positive for 1 detection only received colposcopy cervical biopsy.A total of 569 subjects received the cervical biopsy, and the positive rate was 2.3% (69/3000), while the detection rate for CIN (cervical intraepithelial neoplasia) II and above levels was 1.13% (34/3000). Receiver operator characteristic (ROC) curve analysis showed that, the area under the curve (AUC) value for the careHPV test was 0.671, which was higher than the VIA/VILI (0.619), suggesting higher diagnostic value for the careHPV test. For the Cervista, Cobas 4800, Aptima HPV detection, and TCT methods, the highest AUC value was observed for the TCT method, indicating that the TCT method is the most valuable for the cervical cancer screening.The diagnostic value of careHPV test is superior to the VIA/VILA detection method. The TCT method has the greatest value for the cervical cancer screening. The Cervista HPV detection method should be considered where the conditions are limited.

Self-perceived competence in early diagnosis of cervical cancer among recently graduated physicians from Lima, Peru.

ObjectiveTo assess the prevalence of recently graduated physicians who perceived themselves as adequately competent to perform Papanicolaou (PAP), Visual Inspection with Acetic Acid (VIA), and Visual Inspection with Lugol´s Iodine (VILI); and study its associated factors, in Lima, Peru.MethodsThis cross-sectional study evaluated recently graduated physicians from Lima, Peru. Physicians were considered to perceive themselves as adequately competent if they had answered, "agree" or "strongly agree" when asked if they were competent enough to perform these screening tests. To evaluate the associated factors, prevalence ratios (PR) were calculated using Poisson regressions with robust variance.ResultsOnly 367/432 (86.2%) physicians perceived themselves as adequately competent to perform PAP, 257 (60.5%) to perform VIA, and 247 (58.1%) to perform VILI. Physicians who performed their gynecology/obstetric clerkship at hospitals from the police or armed forces had a higher proportion of perceiving themselves as adequately competent to perform VIA and VILI.ConclusionsNine out of ten physicians perceived themselves as adequately competent to perform PAP, while six out of ten to perform VIA or VILI. The health care system in which the physicians performed their clerkship was associated with the prevalence of adequate self-perceived competence for performing VIA and VILI.

Bridging the gap in health systems through task-sharing: A model of PHC workers’ competency for cervical screening

BackgroundSeveral developing countries have begun implementing the recently proven ‘Screen and treat’ approach using visual inspection methods and cryotherapy. Nonetheless, a dire lack of established screening programs in Nigeria necessitates proffering effective task sharing to improve the availability of screening at the primary care level thereby making it more accessible to women. MethodsThis study employed a cross-sectional, analytic design with competency-based training of health workers to underscore the competence of primary healthcare (PHC) workers to perform cervical screening. The degree of agreement for the visual inspection with acetic acid (VIA) and visual inspection with Lugol’s iodine (VILI) results between the PHC workers and O & G doctors was determined using Kappa statistics, and indices of validity were used to express the accuracy of results. Results Following training, the PHC workers demonstrated a fair to excellent proficiency at the procedures for VIA and VILI, although the phase of VIA/VILI proper was the best performed. The degree of agreement (kappa) between workers for VILI (k - 0.442) and VIA (k - 0.374) was statistically significant (p < 0.001). The sensitivity of VILI among PHC workers (42.9%) was lower than O & G doctors (78.6%), however, PHC had a higher specificity (45.5% vs. 22.7%). The positive predictive values of VILI and VIA were similarly low for both groups (PHC workers vs. O & G doctors - 33.3% vs. 39.3%; 28.6% vs. 27.3%); whereas the negative predictive values for VILI and VIA were moderately better for PHC workers (PHC workers vs. O & G doctors - 62.5% vs. 55.6%; 58.6% vs. 56.0% respectively). The diagnostic accuracy for VILI was the same for both groups of healthcare workers, however VIA accuracy was slightly higher among PHC workers. The sensitivity of VIA was lower among the PHC workers (PHC workers vs. O & G doctors −14.3% vs. 21.4%), who also had a higher specificity (PHC workers vs. O & G doctors - 77.3% vs. 63.6%). ConclusionThe findings of this study suggest that VIA and VILI as done by trained PHC workers is comparable to those performed by registrars of obstetrics and gynecology, which is in keeping with reports from several other studies. This study thus highlights the value of competency-based training for primary healthcare workers in order to accomplish task sharing for cervical screening using visual inspection methods.

SENSITIVITY AND SPECIFICITY OF VISUAL INSPECTION WITH LUGOL’S IODINE S(VILI) IN CERVICAL CANCER.

Introduction: Cervical cancer is the second most common gynecologic cancer worldwide, accounting for 13% of all female cancer in developing countries. Cervical cancer is a disease that can be prevented through both primary prevention and early detection. Pap smear is a screening method which has been used for so long. Hence, one simple diagnostic test namely visual inspection with Lugol 's iodine (VILI) which is based on the ability of the trained healthcare personnel to detect yellow non iodine uptake areas in the cervical transformation zone are currently being evaluated in the experimental setting as potential alternative to cervical cytology. Objective: To determine diagnostic accuracy of visual inspection with Lugol's iodine (VILI) taking histopathology as gold standard among patients of cervical cancer. Subjects and methods: A total of 285 women with early marriage, history of post-coital bleeding, history of post- menopausal bleeding and history of per vaginal discharge were included in study. Women with obvious cervical growth and diagnosed cervical cancer were excluded. I put each patient in the lithotomy position and insert Cusco's speculum to visualize cervix. I cleaned the cervix with cotton soaked with normal saline. Now applied Jugol 's iodine, to the cervix normal squamous epithelium contain glycogen and stain. Conversely premalignant and malignant squamous tissue contain no glycogen and does not stain with iodine. This was schillers test and non-staining areas were schiller positive. For further confirmation I took biopsy from schillers positive area and sent for histopathology. Results: Age range in this study was from 21 to 60 years with mean age of 39.393± 6.66 years and mean duration of disease was 6.031±2.09 months. 43.9% patients were belong to rural area and 56.1% belongs to urban area. 25.6% patients have Family History of cervical cancer. Visual inspection with Lugol's iodine (VILI) diagnosed 43(15.1%) patients and Histopathology diagnosed 15.8% patients with Cervical cancer. Visual inspection with Lugol's iodine (VILI) has shown sensitivity of 86.6%, specificity 98.3%, diagnostic accuracy by 96%, PPV 90.6%, NPV 97.5%, (p=0.000) in diagnosis of Cervical cancer. Conclusion: My study showed VILI good sensitivity and it can therefore be a suitable potential alternative/adjunctive screening test not only in resource-poor settings but also in well-equipped centers. Keywords: Cervical cancer, Visual inspection with Lugol's iodine, Diagnostic accuracy DOI : 10.7176/JMPB/52-07

Comparison of the Accuracy of Papanicolaou Test Cytology, Visual Inspection With Acetic Acid, and Visual Inspection With Lugol Iodine in Screening for Cervical Neoplasia in Southeast Nigeria.

PurposeThis study aimed to compare the accuracy of Papanicolaou test cytology, visual inspection with 5% acetic acid (VIA), and visual inspection with Lugol iodine (VILI) in the detection of premalignant and malignant lesions of the cervix.Materials and MethodsThis was a cross-sectional comparative study of 200 consenting participants at the Federal Teaching Hospital, Abakaliki over a 6-month period. All the participants had Papanicolaou test cytology. Subsequently, they were classified into two groups of 100 each through systematic random sampling: group 1 had VIA and group 2 had VILI. Thereafter, all the participants had cervical punch biopsy at the 6 and 12 o’clock cervical positions. Cervical punch biopsy was also done on the suspicious lesions of the cervix irrespective of their positions. The tests of validity of the three methods were calculated using the histology of the biopsy specimen as the gold standard. P value ≤ .05 was considered to be statistically significant.ResultsAmong the VIA group, 19 (19%) had cervical epithelial abnormalities on Papanicolaou test cytology, and VIA was positive in 14 (14%). Histology results showed cervical neoplasia in 15 (15%) of the participants. Among the VILI group, 15 (15%) had cervical epithelial abnormalities on Papanicolaou test cytology, and VILI was positive in 19 (19%). Histology results showed cervical neoplasia in 15 (15%) of the participants. There was no significant difference in overall accuracy of Papanicolaou test cytology, VIA, and VILI. The overall accuracy of the Papanicolaou test cytology plus VIA was significantly more than Papanicolaou test cytology alone.ConclusionVIA or VILI can be used as a stand-alone cervical cancer screening test when compared with Papanicolaou test cytology, particularly in resource-limited settings. VIA can also complement Papanicolaou test cytology.

Comparing the efficacy of visual inspection of cervix with acetic acid and Lugol's iodine with Pap smear cytology in screening for cancer cervix

Background: Cervical cancer, despite being a preventable disease endangers the lives of significant number of women every year and also its incidence is growing with time. Cervical cytology which is a well-accepted standard screening tool in developed countries but in developing countries like India it fails not only due to the lack of awareness but also due to financial and technical constraints. Visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI) have been evaluated in a number of large clinical trials and is considered to be a possible alternative to cervical cytology for primary cervical cancer screening in low-resource settings. Aim of the Study: (1) The aim of the present study was to compare the efficacy of VIA and Lugol's iodine with Pap smear cytology in screening for cancer cervix and evaluate their usefulness as tools for screening of premalignant and malignant lesions of cervix so that VIA can be used in peripheral areas where cytology is not available. (2) Early detection of pre-cancerous conditions and treating them before they progress to invasive cancer. Methodology: This clinical study was conducted on 200 gynecological patients who were nonpregnant or who had no history suggestive of cervical intraepithelial neoplasia or carcinoma cervix. After taking informed and written consent each woman who fulfilled the inclusion criteria were subjected to Pap smear examination, VIA and VILI. A biopsy was taken in patients with abnormal findings or suspicious findings on VIA/VILI. Results: In the present study, the sensitivity of VIA and VILI was 88.23%, specificity 78.68%, positive predictive value was 53.57%, and negative predictive value was 96% with biopsy as the reference standard. The sensitivity and specificity of cytology in our study were 88% and 52.63%, respectively. Conclusion: VIA and VILI are simple, inexpensive, and low-technology test. Both when combined have high sensitivity as well as specificity. This can be practiced by clinicians and paramedics on a wide scale. Another advantage is immediate availability of results and hence that treatment can be started during the same visit.

Burden of cervical neoplasia in mid-western rural Nepal: a population-based study.

ObjectiveTo assess the burden of cervical neoplasia in mid-western rural, Nepal using cytology, visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI).MethodA cross-sectional, population-based study was conducted. Total of 2,279 married, non-pregnant women aged 20–65 years participated in a screening clinic from May 2016 to January 2017. All eligible women completed self-report of socio-demographic and reproductive health data followed by screening tests. Biopsies were obtained from areas on the cervix assessed by VIA and or VILI to be abnormal. Final disease was confirmed by biopsy report.ResultsA total of 96.09% (n=2,190) women were eligible for this study with mean age 32.78±9.33 years. The overall rate of positive cytology, VIA, and VILI were 3.69%, 12.45%, and 16.89%, respectively. Sixty-two cases were biopsy proven cervical neoplasia. Altogether 78 (3.69%) cases were cytologically abnormal: 25 (1.18%) were atypical squamous cells of undetermined significance, 33 (1.56%) were low-grade squamous intraepithelial lesion, 11 (0.52%) were high-grade squamous intraepithelial lesion, and 9 (0.42%) were squamous cell carcinoma. Illiterate women appeared to be at higher risk for cervical neoplasia (p<0.001). Similarly, age ≥46 years (p<0.013), participant's multiple marriages or sexual partners (p<0.005), and positive human immunodeficiency virus status (p<0.001) were significantly associated with abnormal cytology.ConclusionBased on cytology report, there is 3.69% prevalence of cervical neoplasia among women in a rural region of mid-western, Nepal. A “screen and treat” approach would be more attractive in low resource settings.

Cervical Cancer Screening with Visual Inspection with Acetic Acid and Lugol as Primary Screening Test, a Comparable Result to Conventional PAP Smear in Northern Cameroon

Background: Cervical cancer is a major cause of women death worldwide. The reduction of the mortality and morbidity of this pathology depends on the early detection based on powerful suitable screening methods that will lead to optimal treatment strategies. However in some rural region of developing countries, it is very difficult to get access to standard screening methods, alternative screening methods, cheaper and easy to handle are then useful. Objective: The aim of this work was to test the sensitivity and specificity of VIA (Visual inspection with acetic acid) and VILI (Visual inspection with lugol iodine) as screening test of cervical cancer compared to the Pap Smear, evaluating the feasibility in health formation in the North Cameroon region, of implementing epidemiological surveillance of cervical cancer based on early diagnosis using the VIAVILI association. Method: 309 women age 20 to 62 years were recruited in this study, 307 were included in the statistical analyzes. Each woman was screened for cervical cancer by a conventional Smear and visual inspection with acetic acid 5% and the lugol solution. Results: We found in our study a prevalence of precancerous lesions of cervix at 12.70%. The risks factors of cervical cancer identified are age, matrimonial status, age of first sexual intercourse and parity. The association of VIA and VILI showed a sensitivity, specificity, positive and negative predictive value respectively about 93.58%; 97.01%; 82.01%, 99.04%. Conclusion: Compared to PAP Smear, VIA or VILI could be used as an alternative screening methods for cervical cancer in developing countries. However, histology test was recommended to use a « Gold Standard » to evaluate the test accuracy of VIA/VILI because it can be used to diagnose cancer, while PAP smear cannot.

An Inquiry on the Social and Education Status of Women from Northern Cameroon Suffering Cervical Cancer and the State of Knowledge of their Disease

Background: Cervical cancer is a major cause of women death worldwide. The reduction of the mortality and morbidity of this pathology depends on the early detection based on powerful suitable screening methods, that will lead to optimal treatment strategies. However in some rural region of developing countries, it is very difficult to get access to standard screening methods, alternative screening methods, cheaper and easy to handle are then useful.&#x0D; Objective: The aim of this work was to test the sensitivity and specificity of VIA (Visual inspection with acetic acid) and VILI (Visual inspection with lugol iodine) as screening test of cervical cancer compared to the Pap Smear, evaluating the feasibility in health formation in the North Cameroon region, of implementing epidemiological surveillance of cervical cancer based on early diagnosis using the VIA-VILI association&#x0D; Method: 309 women age 20 to 62 years were recruited in this study, 307 were included in the statistical analyzes. Each woman was screened for cervical cancer by a conventional Smear and visual inspection with acetic acid 5% and the lugol solution.&#x0D; Results: We found in our study a prevalence of precancerous lesions of cervix at 12.70%. The risks factors of cervical cancer identified are age, matrimonial status, age of first sexual intercourse and parity. The association of VIA and VILI showed a sensitivity, specificity, positive and negative predictive value respectively about 93.58%; 97.01%; 82.01%, 99.04%.&#x0D; Conclusion: Compared to PAP Smear, VIA or VILI could be used as an alternative screening methods for cervical cancer in developing countries. However, histology test was recommended to use a « Gold Standard » to evaluate the test accuracy of VIA/VILI because it can be used to diagnose cancer, while PAP smear cannot.

Efficacy of thermoablation in treating cervical precancerous lesions in a low-resource setting.

IntroductionTreating cervical intraepithelial neoplasia (CIN) grades 2 and 3 is the recommended strategy for preventing invasive carcinoma in low- and middle-income countries (LMICs). Our objective was to assess the efficacy of thermoablation in the treatment of CIN2 and CIN3 in a screen-and-treat approach.MethodsWomen aged 30–49 years in Dschang, Cameroon, were invited to undergo vaginal sampling for human papillomavirus (HPV), samples being assessed by an Xpert HPV Assay. HPV-positive women underwent visual inspection with acetic acid (VIA) and visual inspection with Lugol’s iodine (VILI), cervical biopsy, and endocervical curettage. Women positive for HPV-16/18/45 or other HPV types with abnormal VIA/VILI were treated by thermoablation on the same day. The primary outcome was persistence of high-grade disease on cytologic examination at 12 months.ResultsOf a total of 1,012 recruited women, 188 were HPV-positive, 121 patients required thermoablation, and 99 had a CIN of grade <2, making the overtreatment rate 9.9%. The cure rate for CIN2 and CIN3 at 12 months was 70.6%. Failure (higher risk of persistent disease) was associated with the presence of occult endocervical lesions at baseline diagnosis (adjusted odds ratio [aOR] =128.97 [95% confidence interval [CI], 8.80–1,890.95]; p<0.0001). First sexual intercourse before the age of 15 was also a risk factor (aOR =0.003 [95% CI, 0.001–0.61]; p=0.023).ConclusionIn LMICs, use of thermoablation in a screen-and-treat approach is a valuable treatment option for CIN2 and CIN3. Studies comparing thermoablation with cryotherapy are needed to determine the most appropriate treatment for cervical precancer in such countries.

Knowledge and Behavior of Women on Cervical Cancer in the Northern Region of Cameroon

 Background: Cervical cancer is a major cause of women death worldwide. The reduction of the mortality and morbidity of this pathology depends on the early detection based on powerful suitable screening methods, that will lead to optimal treatment strategies. However in some rural region of developing countries, it is very difficult to get access to standard screening methods, alternative screening methods, cheaper and easy to handle are then useful. Objective: The aim of this work was to test the sensitivity and specificity of VIA (Visual inspection with acetic acid) and VILI (Visual inspection with lugol iodine) as a diagnostic test of cervical cancer compared to the Pap Smear, evaluating the feasibility in health formation in the North Cameroon region, of implementing epidemiological surveillance of cervical cancer based on early diagnosis using the VIA-VILI association Method: 309 women age 20 to 62 years were recruited in this study, 307 were included in the statistical analyzes. Each woman was screened for cervical cancer by a conventional Smear and visual inspection with acetic acid 5% and the lugol solution. Results: We found in our study a prevalence of precancerous lesions of cervix at 12.70%. The risks factors of cervical cancer identified are age, matrimonial status, age of first sexual intercourse and parity. The association of VIA and VILI showed a sensitivity, specificity, positive and negative predictive value respectively about 93.58%; 97.01%; 82.01%, 99.04%. Conclusion: Compared to PAP Smear, VIA or VILI could be used as an alternative screening methods for cervical cancer in developing countries, where it is difficult to access to more accurate test such as colposcopy and biopsy.

Retrospective View of Two Years of Colposcopy Practice in a Gynecologic Clinic in Cotonou

Objective: To analyse the colposcopy results at the Gynaecological Clinic of Houeyiho. Patients and methods: Retrospective, descriptive and analytical studies were conducted by the Clinic of Houeyiho in Cotonou from January 2013 to December 2015. Results: 440 women were received in colposcopy including 251 (57%) referred by health workers for VIA (Visual Inspection with Acetique Acid)/VILI (Visual Inspection with Lugol’s Iodine) abnormalities, forty-seven (47) for abnormal smears (10.7%), thirty-eight (38) for metrorrhagia (8.6%). 10% of cases were mainly concerned with post-therapeutic monitoring (six colposcopies of the vagina fundus after hysterectomy for cervical cancer and four after conization). The average age of patients is 41 years within plus or minus 5 years. Forty (40) cases of Grade 1 Atypical Transformation, twenty-nine (29) cases of Grade 2 Atypical Transformation including two (2) cases of leukoplakia (1 post-conization for CINIII, 1 in a HIV+ patient), ten (10) cases of Grade 1 Atypical Transformation/Grade 2 Atypical Transformation association were recorded. A colposcopy biopsy was performed in 95 patients meaning 21.6% of patients. Five biopsies were realized for a cervical neoplasia suspicion and were sent to Pasteur Cerba laboratory in France for the sake of efficiency and rapidity of results. In Grade 1 Atypical Transformation, 66.6% of CIN1 and condylomata plana were noted. Nevertheless, a case of mucinous adenocarcinoma with metaplasia has been discovered in a TAG1 with a 23-year old patient. In Grade 2 Atypical Transformation, the histology reveals 44.4% of CIN 1, 40.7% of severe dysplasia and 11.1% of carcinomas. Conclusion: The colposcopy may be a good screening method with a good colpo-histology agreement in Cotonou. But it’s relatively expensive (20.000 CFA francs) and the reduced number of colposcopists restricts its use in Benin.

Dedicated researcher brings cancer care to rural communities

&lt;div&gt;As an ardent cancer researcher, Dr. Smita Asthana has a vision to create wider awareness on cancer and its prevention, and aims to work on translational research to benefit the general public through the implementation of evidence-based research. “I have been associated with the National Institute of Cancer Prevention and Research (NICPR) and Institute of Cytology and Preventive Oncology (ICPO) since November 2004 and have progressed over a period of time from being a staff scientist to the current role of a senior scientist,” says Dr. Asthana, who is presently with NICPR’s Biostatistics and Epidemiology division.&lt;/div&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;“I have been working in various positions that deal with the design, execution, and evaluation of medical projects. Recently, we have concluded two major cervical cancer screening projects and conducted a screening of 10,000 women in rural areas,” she tells AMOR. One project, funded by the Indian Council of Medical Research, was carried out 100 km west of New Delhi in the rural town of Dadri “as part of an operational research to see the implementation of VIA (visual inspection with acetic acid) and VILI (visual inspection with Lugol's iodine) screenings with the help of existing healthcare infrastructure,” she explains.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;As a leading researcher in cervical cancer screening, she completed an Indo-US collaborative project on the clinical performance of a human papillomavirus (HPV) test, used as a strategy for screening cervical cancer in rural communities, with funding from the Bill and Melinda Gates Foundation via the international non-profit global health organization PATH. “The primary objective of the project was to observe the performance of careHPV, a new diagnostic kit, in a rural setup,” she says.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;CareHPV is a highly sensitive DNA test, which detects 14 different types of the human papillomavirus that cause cervical cancer, providing results more rapidly than other DNA tests and is designed especially for use in clinics that lack reliable clean water or electricity. It is an incredibly cost-effective option for low-resource countries seeking to develop national cervical cancer screening and treatment programs according to PATH.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;“Both projects were completed successfully and brought out research conclusions in the form of national and international publications,” Dr. Asthana says. In addition to the projects, she had also developed health education materials to create cervical cancer awareness among the women of rural Indian community, while providing training to auxiliary nurses and midwives for cervical cancer screening.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;Dr. Asthana graduated with a degree in Bachelor of Medicine and Bachelor of Surgery from King George Medical College (KGMC), Lucknow, Uttar Pradesh, India, before pursuing her Doctor of Medicine (MD) in Community Medicine from Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, India.  Throughout her career, she has published over 40 articles in national and international journals. As a result of her hard work and dedication toward the medical field, she has been awarded first prizes for oral presentation in international conferences such as Indian Cancer Congress (ICC 2014) and Asia Oceania Research Organisation on Genital Infections and Neoplasia (AOGIN 2012).&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;She is an active member of various scientific associations and societies such as the Indian Association for Cancer Research (IACR), Indian Society for Medical Statistics (ISMS), Indian Association of Preventive and Social Medicine (IAPSM), and International Epidemiological Association (IEA). In her effort to provide impactful messages via research publications, she is currently working on remodeling the cancer registry data, which includes a diversified field for incidence of childhood cancer, breast and cervical cancer, trends of major cancer, cancer burden in Northeast of India, among other things.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;According to Dr. Asthana, her vision is the utilization of voluminous cancer registry data to produce comprehensive reports in the form of research communication to give a clearer picture of different cancer burden in various Indian registries. “I have also proposed a project for establishing cancer registry at NICPR, which was approved by the Indian Council of Medical Research (ICMR) in principle, but we are currently still waiting for funding,” says the medical scientist.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;Focusing on the area of cancer epidemiology and research methodology, Dr. Asthana has faced many challenges commonly encountered by any researcher with a vision to improve medical research. “Gradually, with time and experience, I have overcome these limitations and I now conduct research methodology workshops to help clinicians have a better orientation toward research,” she says. Dr. Asthana is the coordinator of research methodology workshops, which is a series of training courses that started in 2007. Training courses/workshops are being conducted on a regular basis — two to three times a year at ICPO — and on an invitation basis, she has held workshops at other institutions such as her previous visit to Universiti Teknologi PETRONAS in Malaysia to train 30 PhD students.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;“The main aim or idea is to educate scientists/researchers and medical faculties about the basics of research methodology, which consist of descriptive statistics, statistical analysis, and clinical trial sampling, as well as research protocol development and scientific reporting/writing,” she elaborates. “The curriculum was formed and executed in such a way that new scientists gain an overall knowledge on how a research project should be planned, executed, and the results communicated,” she adds. The courses, according to her, are targeted for medical faculty members, medical post-graduate students, undergraduate students, and PhD students with a basic science background from various medical institutions.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;As a researcher with almost 14 years of experience in medical research, her passion for research does not end there. Dr. Asthana has also ventured into various other new areas that are currently lacking presence in India and other low- and middle-income countries. One such area is palliative care, where she has undergone specialized training in palliative care from the Indian Association of Palliative Care. Additionally, Dr. Asthana is working on a global systematic review project that studies smokeless tobacco attributable risk for oral cancer. She further adds, “As an officer in the district technical support team and in collaboration with World Health Organization, I have devoted quite some time in serving the rural community for leprosy monitoring.”&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;When asked for her opinion about the future of cancer research, Dr. Asthana believes that targeted therapy is the future of cancer therapy, as it kills only cancer cells and not normal cells, which leads to lesser side effects. “However, the major concern is the cost of it,” she says, “and it doesn’t appear to be affordable in the near future.” Hence, “developing countries like India should focus on the prevention of cancer through the modification of risk factors and adopting healthy lifestyles,” she concludes.&lt;/p&gt;

Burden of cervical cancer and role of screening in India.

Background:Cervical cancer is a major cause of cancer mortality in women and more than a quarter of its global burden is contributed by developing countries. In India, in spite of alarmingly high figures, there is no nationwide government-sponsored screening program. This study was conducted to assess the burden of cervical cancer in India and review the performance characteristics of available cervical cancer screening tools, so as to provide evidence-based recommendations for application of most practically suited screening test to be used in resource-poor field settings.Materials and Methods:MEDLINE and Web of Science electronic database were searched from January 1990 to December 2015, using the keywords such as “cervical cancer”, “screening”, “early detection”, “cervical cytology” and “visual inspection”, and their corresponding MeSH terms in combination with Boolean operators “OR, AND.” Two authors independently selected studies that are published in English and conducted in India. A total of 11 studies were found to be relevant and eligible to be included in the present study.Results:In India, cervical cancer contributes to approximately 6–29% of all cancers in women. The age-adjusted incidence rate of cervical cancer varies widely among registries; highest is 23.07/100,000 in Mizoram state and the lowest is 4.91/100,000 in Dibrugarh district. The pooled estimates of sensitivity and specificity of visual inspection with acetic acid (VIA), magnified VIA, visual inspection with Lugol's iodine (VILI), cytology (Pap smear), and human papillomavirus DNA were found to be 67.65% and 84.32%, 65.36% and 85.76%, 78.27% and 87.10%, 62.11% and 93.51%, and 77.81% and 91.54%, respectively.Conclusions:In developing countries because of lack of necessary infrastructure and quality control, high-quality cytology screening may not be feasible for wide-scale implementation. Hence, cervical cancer screening program based on visual screening test such as VIA/VILI should be adopted as an integral part of primary health-care setup in resource-poor countries like India.

Comparative Analysis of Visual Inspection with Acetic Acid And Lugol’s Iodine And Liquiprep TM in Cervical Cancer Screening with Cervical Biopsy As Gold Standard

Aim: A modified liquid-based cytological technique referred to as the “LiquiPrep TM (LP) system” requires neither expensive equipment nor complicated specimen preparation. The aim of this study was to assess the efficacy of LP in cervical cancer screening by comparing it with VIA(Visual Inspection with Acetic acid) and VILI (Visual Inspection with Lugol’s Iodine) using cervical biopsy findings as gold standard. Methods: Cervical cytology specimens were collected from 200 women. LP sample was taken with the help of a Rover Cervex brush, the tip of which was broken and dropped into the alcohol based LP preservative fluid which was further processed to prepare the slide. They were later screened by VIA and VILI through colposcopy. Cytologic interpretations were classified into following categories: 1)Negative for SIL 2) Cervicitis (3) Atypical cells of undetermined significance 4) Atypical cells cannot exclude HSIL 5) LSIL 6) HSIL 7) Invasive carcinoma. VIA/VILI findings were recorded as positive or negative. Results: The sensitivity was similar for both VIA/VILI and LiquiPrep TM (94.55%). However the specificity was higher for LiquiPrep TM (86.36%). LiquiPrep TM (94.55%) had a higher positive predictive value and negative predictive value (86.36%) than VIA/VILI. The percentage of false positives was higher with VIA/VILI (36.36%) compared with (13.63%). The percentage of false negatives was similar for both LiquiPrep TM and VIA/VILI (5.45%). Conclusions: In conclusion, VIA/VILI can be used as an initial screening test for cervical cancer in a low resource country like India. LiquiPrep TM has a high sensitivity equal to that of VIA/VILI and a comparatively higher specificity and therefore can be used for screening in conditions when there are no financial constrains.

Performance of alternative strategies for primary cervical cancer screening in sub-Saharan Africa: systematic review and meta-analysis of diagnostic test accuracy studies

Objective To assess and compare the accuracy of visual inspection with acetic acid (VIA), visual inspection with Lugol’s iodine (VILI), and human papillomavirus (HPV) testing as alternative standalone methods for...