Background: Due to lack of infrastructure and expertise to process the cytology-based screening tests, the incidence of cervical cancer is continuing to be high in India. There is evidence to show that if women have access to screening, the incidence can be brought down.
Aim: To evaluate the integration of a low-tech screening test using Visual Inspection with Acetic acid (VIA) and treating with cryotherapy services with the existing primary health care programme could potentially improve access to screening and contribute to reduction of incidence of advanced cervical cancer disease.
Methods: The Rural Unit of Health and Social Affairs(RUHSA), an outreach health care division of Christian Medical College, Vellore, Tamilnadu, India has been providing cervical cancer screening facility using Visual Inspection with Acetic acid (VIA) application by the trained outreach nurses in 18 of the sub-centers in the block(administrative unit of a district with 100,000 population) and treating with colposcopy guided cryotherapy at secondary care hospital since 2008.
Results: During the period, 5001 women were screened and of them 60 were VIA positive, 20 were treated with cryotherapy; 116 women had invasive cancer and of them 1, 5,1,24 were diagnosed to have stage IA, IB, IIA, IIB disease respectively and the remaining had IIIA and more advanced stage disease. Many of the women who had early disease were asymptomatic and identified while they visited the outreach health post for screening.
Conclusions: Providing VIA based cervical cancer screening, integrating with the existing primary health care programme by trained health care workers and then a single visit approach for colposcopy and management at secondary care hospital can prevent and down-stage cervical cancer in resource poor settings.