Inexpensive cervical cancer screening method devised

Researchers at a city hospital have found an inexpensive way to screen for cervical cancer by visual inspection with acetic acid (VIA) method, which they state is as good as a pap smear test.

PTI| Updated: Oct 13, 2014, 15:24 PM IST

New Delhi: Researchers at a city hospital have found an inexpensive way to screen for cervical cancer by visual inspection with acetic acid (VIA) method, which they state is as good as a pap smear test.

VIA--an effective screening method for cervical lesions which costs just Rs 2--can be used as a potent screening modality in low resource settings especially in developing countries like India where the expertise for definitive tests is not available in rural and semi-urban areas, according to researchers of the department of Obstetrics and Gynaecology (O&G) at Sir Ganga Ram Hospital here.

The study, which was published in the August 2014 edition of Journal of Current Medicine Research and Practice, found that VIA as compared to Pap smear test is not only an easy to use test but also easy to interpret and reliable with quick results.

Pap smear is laboratory-based test and costs around Rs 1000. Besides it may not be available everywhere.

The results of VIA are available immediately whereas for Pap smear, it requires a follow up visit.

The researchers performed a cross sectional study on 500 women to evaluate the utility of VIA for screening of pre-cancerous or cancerous lesions of cervix and compared it with Papanicolaou smear (Pap smear).

The study, which was approved by institutional review board and ethics committee, was conducted in the outpatient department of O&G between November 2008 to 2010.

Cancer of the uterine cervix is the most common and rapidly growing challenge for India, after breast cancer, affecting Indian women, with an estimated 142,000 new cases coming to light every year and 77,000 women dying of the disease.

The disease is caused by infection with a virus called human papilloma virus (HPV). The disease develops slowly and most women experience no symptoms until it reaches advanced stages when treatment is often unsuccessful

Pap smear is the most popular screening tool to detect cervical lesion since the 1960s.

"However, this screening method requires an established laboratory, a trained cytologist and a repeat visit for its report and further evaluation. To overcome these shortcomings specially in resource constrained settings, a visual inspection after application of acetic acid on the cervix is an alternative method for screening of cervical cancer.

"Application of 3-5 per cent acetic acid causes dehydration of cells and surface coagulation of proteins in active cells. This gives white appearance which is called acitowhite areas which is abnormal and needs further evaluation," said Dr Harsha Khullar, corresponding author of the study and senior consultant at department of O&G at SGRH.

"We evaluated the utility of VIA for the diagnosis of pre-invasive and invasive carcinoma cervix and compared with pap smear. We also found that sensitivity of VIA and pap smear in our study to diagnose precancerous and invasive disease was comparable," Khullar said.

"For VIA, sensitivity was 93.1 per cent and for Pap smear was 86.2 per cent. Both screening tests had low specificity, VIA--32.2 and Pap smear--60.0," he said.

According to Dr Geeta Mediratta, author of the study and senior consultant at the department of O&G, "The findings suggest that VIA with a high sensitivity is comparable to pap smear and can be used as an alternate screening test especially in low resource settings where the expertise for definitive tests is not available. VIA is a simple outpatient procedure, inexpensive and results are available immediately.

"The VIA test is not only simple to perform but is also a very cost effective method. To screen 100 patients, the cost of VIA is Rs 200 whereas pap smear on same number of patients cost Rs 20,000," Khullar said. PTI