Safety, acceptability, and feasibility of a single-visit approach to cervical-cancer prevention in rural Thailand: a demonstration project

Gaffikin, Lynne; Blumenthal, Paul D.; Emerson, Mark R.; Limpaphayom, K; Gynaecologists,

doi:10.1016/s0140-6736(03)12707-9

Cited by 194 publications

(42 citation statements)

References 16 publications

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“…These values are close to those found by many authors [1, 4, 12–14]. Acetic acid is cheaper and available while Lugol's iodine is more expensive.…”

Section: Discussionsupporting

confidence: 91%

“…However, using Lugol's is still challenging due to its cost and accessibility. In some remote parts of India repeated shortages have imposed the single use of acetic acid [4]. …”

Section: Discussionmentioning

confidence: 99%

“…Regarding treatment, according to WHO recommendations cryotherapy should be used for CIN1 and conization or LEE for CIN2/3 [4, 16]. Treatment of CIN2 by LEE is still discussed due to obstetric complications when these lesions are found in young women between 25 and 35 years [6, 7, 17].…”

Section: Discussionmentioning

confidence: 99%

“…Since 2005 the World Health Organization (WHO) recommended visual inspection of cervix with acetic acid (VIA) or Lugol's iodine (VILI) as alternative screening techniques for the detection of cervical precancerous lesions. Many field evaluation surveys reported that visual inspection demonstrated diagnostic accuracy close to cytology and was more affordable and easy to perform for nonmedical health workers in developing countries [2, 4]. Côte d'Ivoire is now planning to implement a national cervical cancer screening program and the screening technic as well as the entry point to screen a maximum of women that are questions of interest.…”

Section: Introductionmentioning

confidence: 99%

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Cervical Cancer Screening Program by Visual Inspection: Acceptability and Feasibility in Health Insurance Companies

Horo

Coulibaly

Abdoul

et al. 2015

Obstetrics and Gynecology International

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Objective. To assess willingness to participate and diagnostic accuracy of visual inspection for early detection of cervical neoplasia among women in a health insurance company. Patients and Method. Cervical cancer screening was systematically proposed to 800 women after consecutive information and awareness sessions. The screening method was visual inspection with acetic acid (VIA) or Lugol's iodine (VILI). Results. Among the 800 identified women, 640 (82%) have accepted the screening, their mean age was 39 years, and 12.0% of them were involved in a polygamist couple. 28.2% of women had prior cervical screening. VIA has been detected positive in 5.9% of women versus 8.6% for VILI. The sensitivity was 72.9% and specificity was 95.2% for VIA versus 71.2% and 97.3% for VILI respectively. The histological examination highlighted a nonspecific chronic cervicitis in 4.6%, CIN1 lesions in 5.91%, and CIN2/3 in 1.2% of the cases. Conclusion. Cervical cancer screening by visual inspection showed appropriate diagnostic accuracy when used to detect early cervical lesions. It is a simple and easy to perform method that could be introduced progressively in the health insurance policy while waiting for a national screening program.

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“…These values are close to those found by many authors [1, 4, 12–14]. Acetic acid is cheaper and available while Lugol's iodine is more expensive.…”

Section: Discussionsupporting

confidence: 91%

“…However, using Lugol's is still challenging due to its cost and accessibility. In some remote parts of India repeated shortages have imposed the single use of acetic acid [4]. …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cervical Cancer Screening Program by Visual Inspection: Acceptability and Feasibility in Health Insurance Companies

Horo

Coulibaly

Abdoul

et al. 2015

Obstetrics and Gynecology International

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“…Over the past decade, a variety of efforts (including randomized clinical trials) have demonstrated the utility of noncytological prevention methods such as visual inspection with acetic acid (VIA) and human papilloma-virus (HPV)–DNA testing [3,4]. While such efforts have shown the safety, acceptability, feasibility and clinical effectiveness of such ‘screen and treat’ (linking screening test results to immediate cryotherapy) prevention services for reducing cervical cancer incidence and mortality in the developing world, measuring effectiveness in routine program implementation settings has remained a challenge [3-6]. …”

mentioning

confidence: 99%

Implementation of Cervical Cancer Prevention Services for HIV-Infected Women in Zambia: Measuring Program Effectiveness

Parham¹,

Mwanahamuntu

Sahasrabuddhe

et al. 2010

HIV Ther.

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Background Cervical cancer kills more women in low-income nations than any other malignancy. A variety of research and demonstration efforts have proven the efficacy and effectiveness of low-cost cervical cancer prevention methods but none in routine program implementation settings of the developing world, particularly in HIV-infected women. Methods In our public sector cervical cancer prevention program in Zambia, nurses conduct screening using visual inspection with acetic acid aided by digital cervicography. Women with visible lesions are offered same-visit cryotherapy or referred for histologic evaluation and clinical management. We analyzed clinical outcomes and modeled program effectiveness among HIV-infected women by estimating the total number of cervical cancer deaths prevented through screening and treatment. Results Between 2006 and 2008, 6572 HIV-infected women were screened, 53.6% (3523) had visible lesions, 58.5% (2062) were eligible for cryotherapy and 41.5% (1461) were referred for histologic evaluation. A total of 75% (1095 out of 1462) of patients who were referred for evaluation complied. Pathology results from 65% (715 out of 1095) of women revealed benign abnormalities in 21% (151), cervical intraepithelial neoplasia (CIN) I in 30% (214), CIN 2/3 in 33% (235) and invasive cervical cancer in 16.1% (115, of which 69% were early stage). Using a conditional probability model, we estimated that our program prevented 142 cervical cancer deaths (high/low range: 238–96) among the 6572 HIV-infected women screened, or one cervical cancer death prevented per 46 (corresponding range: 28–68) HIV-infected women screened. Conclusion Our prevention efforts using setting-appropriate human resources and technology have reduced morbidity and mortality from cervical cancer among HIV-infected women in Zambia. Financial support for implementing cervical cancer prevention programs integrated within HIV/AIDS care programs is warranted. Our prevention model can serve as the implementation platform for future low-cost HPV-based screening methods, and our results may provide the basis for comparison of programmatic effectiveness of future prevention efforts.

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Screen-and-Treat Approaches for Cervical Cancer Prevention in Low-Resource Settings

Denny¹,

Kuhn²,

Souza³

et al. 2005

JAMA

311

261

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ACH YEAR 471 000 CASES AND 233 000 deaths occur from cervical cancer worldwide, of which 80% occur in less-developed countries that have access to less than 5% of global cancer treatment resources. 1 The lifetime risk of a woman developing cervical cancer in a lowresource setting is approximately 2% to 4%. [2][3][4] Cytology-based screening programs have markedly reduced the incidence of cervical cancer in developed countries that have the infrastructure to support these programs. 5 However, screening programs have proven difficult to implement in low-resource settings. There are 2 predominant reasons why cytology-based programs have proven difficult to implement and sustain in low-resource settings. One is the nature of the screening test. 6 Highquality cytology laboratories are difficult to maintain and there are often substantial delays before the results become available. 7 Another is the extensive workup that is typically used for women with abnormal cytological results. In developed countries, women with abnor-

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Safety, acceptability, and feasibility of a single-visit approach to cervical-cancer prevention in rural Thailand: a demonstration project

Cited by 194 publications

References 16 publications

Cervical Cancer Screening Program by Visual Inspection: Acceptability and Feasibility in Health Insurance Companies

Cervical Cancer Screening Program by Visual Inspection: Acceptability and Feasibility in Health Insurance Companies

Implementation of Cervical Cancer Prevention Services for HIV-Infected Women in Zambia: Measuring Program Effectiveness

Screen-and-Treat Approaches for Cervical Cancer Prevention in Low-Resource Settings

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