Cheap cancer test could save thousands of women
Women line up for cervical cancer screening.
While the preferred method for reducing cervical cancer is to encourage as many countries as possible to vaccinate their young women and girls against Human Papillomavirus (HPV) before they are sexually active, there remains the problem about affording the costly vaccine by the poor people of a country like ours. Early screening still remains only hope for thousands of women. For decades Pap smear test has been regarded as a safe, reliable and effective screening device for detecting cancerous and pre-cancerous stages in the cervix. However, because of the laboratory resources and logistics needed to ensure the test, it is not possible introducing it in all the parts of the country, particularly in rural places where cervical cancer is most prevalent. In this context, a method called Visual Inspection using Acetic Acid (VIA) offers a real-time advantage over other screening methods, particularly in our resource-poor settings, with the distinct improvement of diagnosis at early stage to provide rapid treatment. The trials and research regarding VIA reveal that it significantly reduces the incidence and mortality from cervical cancer by detecting it at early stages. Its cost effectiveness, acceptability and safety make it the best in case of population based screening programmes for developing countries. A study recently published in The Lancet medical journal reveals, this simple visual screening test to look for the early signs of cervical cancer reduced the numbers of cases by a quarter. The visual screening test is very simple and the most advantage is that -- a range of healthcare personnel from nurse level to any trained healthcare worker can perform the test. The test performer washes a woman's cervix with 3-5 percent acetic acid, the main ingredient of vinegar and a device -- speculum to hold the cervix open. It is detected by watching with naked eyes the change of its color under a halogen lamp. If the color remains unchanged, there is no precancerous lesion, but if the color turns white, the woman is likely to have a precancerous lesion. After detecting the lesion, she must go to referral for colposcopy (a diagnostic procedure using a magnifying instrument). Reported in The Lancet, the seven year study in India found the test reduced the number of cervical cases by 25 percent and cut the number of deaths from the disease by more than 35 percent. Associate Professor of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Dr Ashrafunnessa, Coordinator of Cervical Cancer Screening Programme said, "In developed countries, cervical cancer related mortality has been reduced significantly through Pap Smear test and Colposcopy. But the effectiveness of these approaches depends on a high level of healthcare infrastructure and accessibility of majority of the population that is not available in our country. Rather a meta-analysis of Pap test accuracy in developing countries like ours revealed that it has relatively less sensitivity and specificity (about 40 percent). In this context, VIA is the effective, cheaper and best method of screening for cervical cancer in our country. We could save thousands of women dying of the disease." Every year, 12 thousand women affected by cervical cancer more -- commonly due to repeated childbirth resulting in lacerations of the cervix and cervicitis (inflammation of cervix). Early sex life, early marriage, multiple sexual partners, venereal disease, Herpes virus, Human Papilloma virus, low socio-economic status, and poor personal hygiene are also associated with higher incidence of cervical cancer. "It accounts about 30 percent of all female cancer, although it is curable, if identified at an earlier stage. But almost 80 percent people come for the treatment only at an advanced stage when it becomes very difficult to treat. This particularly happens in case of the rural woman. It is very important to create VIA facilities in every parts of our country for early detection of cancer" Dr Ashrafunnessa told the correspondent. To detect and prevent cervical cancer, a project on cervical cancer screening (based on VIA method) has already been undertaken in collaboration with the Department of Obstetrics and Gynecology of BSMMU and UNFPA. Under this project, 31 district hospitals, 31 Maternal and Child Welfare Clinics (MCWC) and a few numbers of doctors, nurses and healthcare providers and District Hospitals have been trained so far. They are providing services for screening of cervix for detection and primary treatment of cervical cancer and referring the VIA positive cases to the referral hospitals. But still it is under focused and the facility is not available all over the country. This must go hand in hand with increasing the awareness of women about cervical cancer and prevention towards an organised system of referral to monitor treatment outcomes of these women. The key to success is providing highly effective training of personnel and ensuring that quality control standards at all parts of the procedure. While prevailing conditions do differ dramatically in resource-poor nations, experts recommended setting up this screening programme in entire population, parallel to immunisation programmes, if we want to have a significant impact on the incidence and mortality from this common cancer. Key messagesVIA tests is done free of cost. Experts emphasis that VIA test facility should be provided all over the country as soon as possible and stress on early detection at cancerous and pre-cancerous stage. They recommended every women aged 30 and onwards should done the VIA test in the specific center and also it is needed for women aged 25 who married early. It should be done every three years interval. The signs of cervical cancer include any kind of menstrual disturbances, irregular bleeding, pain in the waist or lower abdomen or thigh. If anyone notices these problems should consult with the nearest healthcare centers. Every one should remember that cervical cancer is fully curable if detected early.
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