Prevalence of Premalignant and Malignant Cervical Lesions among Patients by Visual Inspection with Acetic Acid (VIA) in a Tertiary Care Hospital in Bangalore- An Observational Study

Abstract

BACKGROUNDCervical cancer continues to be a major public health problem in India in the absence of widespread organized cervical screening programs. Visual inspection of the cervix with acetic acid (VIA) is an effective, inexpensive screening test that can be combined with simple treatment procedures for early cervical lesions, provided by trained health workers. We report 2 years' experience in early detection of cervical cancer and pre-cancers using the VIA test in a tertiary care hospital in Bengaluru, India. We wanted to study the prevalence of malignant and premalignant cervical lesions by VIA with acetic acid in Bangalore Baptist Hospital, Bangalore and study the demographic factors associated with malignant and premalignant lesions of cervix among the same population.METHODSThis is a cross-sectional study. Eligible women aged between 20 years (sexually active) and 60 years were screened using the VIA test for 2 years. Women who tested positive were further evaluated by taking punch biopsy.RESULTSA total of 516 women were screened by a single round of VIA testing with a positive rate of 11.2% and 3.5% were biopsy positive. Out of 516 women, VIA was positive in 58 cases (11.2%). Biopsy done in 57 cases and biopsy was positive in 18 cases (3.5%). Biopsy reports showed 9 women with squamous cell carcinoma, 1 with adenocarcinoma, 1 with CIN1, 3 with CIN3, 4 with koilocytic atypia. Positive predictive value for VIA is 30%. Prevalence of premalignant and malignant lesions of cervix is 3.5%.CONCLUSIONSOur study reports experience of implementing VIA based cervical screening method in patients attending gynaecology OPD in a tertiary care hospital. VIA is a simple and affordable screening test with acceptable sensitivity and specificity in the range of 50-88.6% and 66.7-89.7% respectively. These results have important implications for efficient service delivery in cervical screening programs in low resource settings.