With the change in the life styles and demographic profiles of
developing countries, non communicable diseases are emerging
to be important health problems that demand appropriate
control program before they assume epidemic proportion.
One of these is the problem of cancer (1). Cervical cancer is
the second most common gynecologic cancer worldwide
accounting for 13% of all female cancer in developing countries
(2). The important reasons for higher cervical cancer incidence
in developing countries are lack of resources, lack of
effective screening programs and poorly organized health system
aimed for detecting precancerous condition before they
progress to invasive cancer. So, there is a need of low cost approach
for effective cervical cancer screening programs (3).
Cervical cancer is a disease that can be prevented through both
primary prevention and early detection. So in developed countries
the incidence of cervical cancer has decreased due to
screening, early detection and treatment. However in developing
countries, 80% of cervical cancers are incurable at the time
of detection due to their advanced stage (4). Several screening
modalities are now available for early detection of cervical cancer
and its precursor lesions. They all differ with regard to their
test characteristic, feasibility and economic considerations.
The different screening modalities have been cytology or Pap
smear, visual inspection, using acetic acid (VIA) or Lugols iodine,
VIA with magnification (VIAM) and high risk human
papilloma virus (HPV) screening (5). Cytologic methods of
screening for cervical cancer, precursors have become the main
stay of population based prevention programs resulting in substantial
reduction of disease in developed countries where mass
screen is systemic rather than opportunistic
The Papanicolaous (PAP) smear is a simple, safe, non invasive
and effective method for detection of precancerous, cancerous
and noncancerous changes in the cervix and vagina (7).
Although this effectiveness of PAP smear, sustaining high-quality
cytology based program is difficult in low -resource setting
due to its complex process of collection, sample, preparation,
staining, reading, reporting and the delay between screening
and PROVISION of test results. So, in these areas it should
be directed toward cost-effective strategies that are more inexpensive
and their qualities can be trusted (8). An alternative test
is visual inspection of the cervix with acetic acid (VIA). It has
been advocated as an alternative screening method to PAP
smears in developing countries (9). The attractive features of
VIA include low cost, simple administration, real-time screening
of results and accuracy comparable to good quality PAP
smears. In developing nations, resources are limited so, VIA
as a visual screening test does not depend on laboratory services
would be a possible and promising alternative screening tool for
early detection of cervical cancer (10,11). This study was designed
to evaluate the clinical performance of visual inspection
with acetic acid (VIA) as a simple test and if it is a suitable alternative
to PAP smear for early detection of cervical cancer.