DOI QR코드

DOI QR Code

Cervical Screening Using Visual Inspection with Acetic Acid (VIA) and Treatment with Cryotherapy in Fiji

  • Fong, James ;
  • Gyaneshwar, Rajaneshwar ;
  • Lin, Sophia ;
  • Morrell, Stephen ;
  • Taylor, Richard ;
  • Brassil, Ann ;
  • Stuart, Anne ;
  • McGowan, Catherine
  • Published : 2015.01.22

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.

Keywords

Cervical cancer;cryotherapy;Fiji;screening;visual inspection

References

  1. Arbyn M, Sankaranarayanan R, Muwonge R, et al (2008). Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India. Int J Cancer, 123, 153-60. https://doi.org/10.1002/ijc.23489
  2. Basu P, Ghoshal M, Chattopadhyay K, et al (2006). Cervical screening by visual inspection with acetic acid (VIA) is well accepted by women-results from a community-based study in rural India. Asian Pac J Cancer Prev, 7, 604-8.
  3. Chamot E, Kristensen S, Stringer JSA, Mwanahamuntu MH (2010). Are treatments for cervical precancerous lesions in less-developed countries safe enough to promote scaling-up of cervical screening programs? a systematic review. BMC Womens Health, 10, 11. https://doi.org/10.1186/1472-6874-10-11
  4. Chumworathayi B, Blumenthal PD, Limpaphayom KK, et al (2010). Effect of single-visit VIA and cryotherapy cervical cancer prevention program in Roi Et, Thailand: a preliminary report. J Obstet Gyn Res, 36, 79-85. https://doi.org/10.1111/j.1447-0756.2009.01089.x
  5. Demirtas B (2013). Review of strategies in promoting attendance for cervical screening. Asian Pac J Cancer Prev, 14, 3263-67. https://doi.org/10.7314/APJCP.2013.14.5.3263
  6. Ferlay J, Soerjomataram I, Ervik M, et al (2013). GLOBOCAN 2012: Cancer incidence and mortality worldwide, version 1.0, Lyon: international agency for research on cancer, IARC cancer base No. 11.
  7. Foliaki S, Best D, Akau'ola S, et al (2011). Cancer incidence in four pacific countries: Tonga, Fiji Islands, Cook Islands and Niue', Pacific Health Dialog, 17, 21-32.
  8. Gaffikin L, Blumenthal PD, Emerson M, et al (2003). Safety, acceptability, and feasibility of a single-visit approach to cervical-cancer prevention in rural Thailand: a demonstration project. Lancet, 361, 814-20. https://doi.org/10.1016/S0140-6736(03)12707-9
  9. Isaac R, Finkel M, Olver I, et al (2012). Translating evidence into practice in low resource settings: cervical cancer screening tests are only part of the solution in rural India. Asian Pac J Cancer Prev, 13, 4169-72. https://doi.org/10.7314/APJCP.2012.13.8.4169
  10. Kuehn R, Fong J, Taylor R, Gyaneshwar R, Carter K (2012). Cervical cancer incidence and mortality in Fiji 2003-2009. ANZ J Obstet Gynaecol, 52, 380-6.
  11. Laara E, Day NE, Hakama M (1987). Trends in mortality from cervical cancer in the Nordic countries: association with organised screening programmes. Lancet, 8544, 1247-9.
  12. Luciani S, Munoz S, Gonzales M, Delgado JM, Valcarcel M (2011). Effectiveness of cervical cancer screening using visual inspection with acetic acid in Peru. Int J Gyn Obs, 115, 53-6. https://doi.org/10.1016/j.ijgo.2011.05.014
  13. Moon TD, Silva-Matos C, Cordoso A, et al (2012). Implementation of cervical cancer screening using visual inspection with acetic acid in rural Mozambique: successes and challenges using HIV care and treatment programme investments in Zambezia Province. J Int AIDS Soc, 15, 17406.
  14. Nessa A, Nahar KN, Begum SA, et al (2013). Comparison between visual inspection of cervix and cytology based screening procedures in Bangladesh. Asian Pac J Cancer Prev, 14, 7607-11. https://doi.org/10.7314/APJCP.2013.14.12.7607
  15. Parashari A, Singh V (2013). Reasons for variation in sensitivity and specificity of visual inspection with acetic acid (VIA) for the detection of pre-cancer and cancer lesions of uterine cervix. Asian Pac J Cancer Prev, 14, 7761-2. https://doi.org/10.7314/APJCP.2013.14.12.7761
  16. Phongsavan K, Phengsavanh A, Wahlstrom R, Marions L (2011). Safety, feasibility, and acceptability of visual inspection with acetic acid and immediate treatment with cryotherapy in rural Laos. Int J Gyn Obs, 114, 268-72. https://doi.org/10.1016/j.ijgo.2011.03.009
  17. Prasad K, Fong J (2007). The effectiveness of cervical cancer screening programme at colonial war memorial hospital, Fiji Med J, 26, 9-12.
  18. Sankaranarayanan R, Wesley R (2003). A practical manual on visual screening for cervical neoplasia. lyon: international agency for research on cancer, IARC technical publication No. 41.
  19. Sankaranarayanan R, Basu P, WesleY R, et al (2004). Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa. International J Cancer, 110, 907-13. https://doi.org/10.1002/ijc.20190
  20. Sankaranarayanan R, Nene BM, Dinshaw KA, et al (2005). A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India. Int J Cancer, 116, 617-23. https://doi.org/10.1002/ijc.21050
  21. Sankaranarayanan R, Rajkumar R, Esmy PO, et al (2007a). Effectiveness, safety and acceptability of 'see and treat' with cryotherapy by nurses in a cervical screening study in India. Br J Cancer, 96, 738-43. https://doi.org/10.1038/sj.bjc.6603633
  22. Sankaranarayanan R, Esmy PO, Rajkumar R, et al (2007b). Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial. Lancet, 370, 398-406. https://doi.org/10.1016/S0140-6736(07)61195-7
  23. Sankaranarayanan R, Nene BM, Shastri SS, et al (2009). HPV screening for cervical cancer in rural India. N Engl J Med, 360, 1385-94. https://doi.org/10.1056/NEJMoa0808516
  24. Sauvaget C, Fayette JM, Muwonge R, Wesley R, Sankaranarayanan R (2011). Accuracy of visual inspection with acetic acid for cervical cancer screening. Int J Gynecol Obstet, 113, 14-24. https://doi.org/10.1016/j.ijgo.2010.10.012
  25. Shastri SS, Mittra I, Mishra GA, et al (2014). Effect of VIA screening by primary health workers: randomized controlled study in Mumbai, India. J Natl Cancer Inst, 106, dju009. https://doi.org/10.1093/jnci/dju009
  26. Sigurdsson K (1999). The Icelandic and Nordic cervical screening programs: trends in incidence and mortality rates through 1995. Acta Obstet Gynecol Scand, 78, 478-85. https://doi.org/10.1080/j.1600-0412.1999.780602.x
  27. Taylor R, Morrell S, Mamoon H, Wain G, Ross J (2006). Decline in cervical cancer incidence and mortality in New South Wales in relation to control activities (Australia). Cancer Causes Control, 17, 299-306. https://doi.org/10.1007/s10552-005-0515-z
  28. WHO (2012) Prevention of cervical cancer through screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy. a demonstration project in six African countries: Malawi, Madagascar, Nigeria, Uganda, the United Republic of Tanzania, and Zambia. Geneva: World Health Organization.
  29. WHO (2013). WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. Geneva: World Health Organization.

Cited by

  1. Cervical cancer screening in rural Madagascar: Feasibility, provision and incidence rates vol.9, pp.1, 2017, https://doi.org/10.1007/s12611-016-0392-6