Nip it in the Bud

Women in rural areas rarely get an opportunity to get any gynaecological examination done. An expert committee of the Ministry of Health and Family Welfare,Government of India recommended that women between 30 to 60 years of age should be screened by Visual Inspection with Acetic Acid (VIA),since setting up Pap smear facility in the rural areas is not feasible,Dhorepatil said.

Dr Smita Joshi, Asst Professor,Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI) and Dr Anita Patil,Professor and Head of the Department,Bharti Vidyapeeth Homeopathic Medical College,were the co investigators in the project. The project was Indian Medical Association (Pune Branch)’s initiative to demonstrate feasibility of community based cervical cancer screening services to rural women as a public-private partnership in order to detect and treat women who are likely to develop cervical cancer in future.

The VIA test can be performed by trained health workers and the test positive women can immediately be advised to undergo colposcopy (if the facility exists) or a biopsy may be taken and they can undergo immediate treatment using an ablative method. Most of the detected precancers can be treated by cryotherapy or cold coagulation even in the rural clinics as it is safe,inexpensive,easy to perform and almost as effective as excisional methods of treatment.

This ‘see and treat’ approach can be implemented at the same sitting without waiting for the biopsy report. This ensures high compliance to treatment and improves the efficiency of the program. The patients with pre cancers not suitable for immediate treatment will be referred to the government-supported regional cancer centers (RCC) that provide tertiary cancer care at an affordable cost,explained Dhorepatil.

With the availability of the VIA (Visual Inspection by Acetic Acid) & VILI (Visual Inspection by Lugol’s Iodine) which are low-cost and more accurate screening tests,a demonstration program of ‘see and treat’ strategy was conducted by the IMA (Pune Branch). At least ten such women were detected positive after the VIA test was done. So once these women are detected in the pre cancerous stage we can initiate early treatment and help save lives,says Dhorepatil.