FEATURE OBS/GYNE
«Visual inspection methods present an appropriate strategy screening in low resource settings, these methods are prone to subjectivity»
as systematic call, recall, follow-up and surveillance systems. Therefore, cytology based screening is difficult to implement and sustain in settings with limited resources. To screen successfully in low-resource
settings, the following requirements are essential: One stop clinic for screening, diagnosis and treatment provided on-site. These clinics should be accessible to the majority of at-risk women
Low-cost, low-technology screening test that can lead to immediate treatment of abnormalities
Wide coverage of at-risk women Appropriate educational programs directed towards health workers and women to ensure correct implementation and high participation
cervical tumours with 97% of cancers containing HPV DNA. There are over 100 subtypes of the HPV virus; two high risk genotypes, HPV 16 and 18. These are responsible for the majority of HPV associated cancers of the anogenital tract. The peak prevalence of HPV infection occurs in the late teens and early twenties following onset of sexual activity. A HPV infection usually resolves spontaneously in nine to 12 months, but may persist in a minority of individuals with the subsequent development of precancerous cervical lesions. If left untreated these may progress to cervical cancer over a period of 10-30 years. During persistent HPV infection, precancerous changes may be detected in the cervix; therefore early detection and treatment of these changes is an effective strategy for the prevention of cervical cancer and forms the basis of cervical screening programmes.
SCREENING Even though the impact of cytology screening has never been proved through randomized trials, it has been
Arab Health Issue 3 2011 21
shown to be effective in reducing the incidence and mortality from cervical cancer in developed countries by as much as 60-80%. The success of cytology based screening however requires fully integrated screening program including: established laboratories, highly trained cytotechnologists, and up to three visits for screening, evaluation of cytologic abnormalities and treatment as well
Built-in mechanism for evaluation of the screening program. A number of different tests have been
developed and investigated over the years as alternative screening tests to cytology. The two most widely studied alternative approaches to cervical cancer prevention are visual inspection (with acetic acid or Lugol’s iodine) and HPV-DNA testing:
1. Visual inspection with acetic acid (VIA) VIA involves examination of the cervix with the naked eye, using a bright light
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