VIA Can Be Gamechanger In India To Screen Cervical Cancer
Visual Inspection with Acetic Acid (VIA) test of the cervix is currently the most common cervical cancer screening method in under-resourced settings. Cervical cancer morbidity and mortality has been significantly reduced, thanks to successful screening in many countries. But can it be the gamechanger for screening cervical cancer in India?
The topic was discussed in the BW Healthcare Oncology Summit 2023 by Dr Ragini Agarwal, Director - Medical Services, W Pratiksha Hospital; Dr Y M Mala, Director and Professor, Maulana Azad Medical College; Dr Alka Gupta, Obstetrics in gynaecology, CK Birla Hospitals; Dr Divya Singhal, Consultant - Obstetrics And gynaecology, DGF North; Dr Kavita Dhanasekaran, Scientist - clinical oncology; and Dr Shweta Balani, Senior Consultant and Unit Head - Department of Obstetrics and Gynaecology, Sant Paramananda Hospital.
Moderating the panel, Dr Amita Suneja, Director Professor and HOD, UCMS and GTBH said that 70 per cent of the women should be screened for cervical cancer when eligible. The other spokespersons elaborated their practice of screening women. They highlighted the three main modalities of screening are HPV test, VIA and pap smear tests.
Dr Kavita said, "India is actually a good resource country but the resources are scattered. Right now the country is not hpv-ready because it has a lot of admin to put everything together so that the program does not fail. But it is good that our country has already started screening programme. We are doing VIA in a slow pace but we will transition."
Talking about one of the modalities, Dr Ragini said that pap smear can be a gamechanger but people are still not aware of it. "Even women who are in a better background won't get proper colposcopy everywhere. VIA along with the immediate treatment and pap smear in the OPD is a good thing," she added.
In countries like India, where HPV is not feasible and cytology still has a drawback of frequent testing, VIA becomes the most feasible option comparatively, said Dr Alka. "Its a very easy and acceptable test to the patient. Being cost-effective, its specificity is also good. The test has significant reduction in the both incidence and mortality as said by several studies."
Dr Mala said, "In a country with diversity, VIA is a promising tool for screening cervical cancer. If talked about sensitivity, it is from 18-82 per cent, and the specificity is 80-90 per cent. But when we talk about efficacy, decrease in the incidence and mortality of cervical cancer can be seen. The accuracy is also reasonable in VIA."
While speaking on the same, Dr Divya said that the healthcare experts should not just stick to VIA but also do VILI because it increases the sensitivity and specificity of the whole procedure. Both should be done together. "As far as the target population is concerned, patients between 25-65 age who have been sexually active, should have done VIA atleast once at 30-39 years of age. Though post-menopausal women should not be tested with this because the transformation zone is difficult to catch during that stage."
Talking about VIA protocol Dr Shweta said, "It is a single-visit screen and treat protocol, and for the government of India, they advocate doing every 5 years if it is negative and if positive then look at ablative criteria. But the WHO's latest guidelines suggest doing it in every 3 years."
Discussing on the VIA test for cervical cancer, the speakers agreed that it is a powerful tool that can help in reducing cases and mortality of patients. Also, they accepted that more awareness and counselling is needed among women who are unaware about cervical cancer, HPV or pap smear test. They said that the trainable group for screening can be all primary healthcare workers.
