Screening by VIA-VILI: A boon for women in developing countries

Aim: To assess the diagnostic accuracy of visual screening methods VIA and VILI(Visual Inspection with Acetic Acid & Visual Inspection with Lugol's Iodine) for early detection of cervical cancer among women in urban slum areas. Materials & Methods: A cross-sectional study was conducted in Department of Obstetrics & Gynaecology at Babu Jagjeevan Ram Memorial Hospital, Delhi from January 2013 to May 2015. Total of 1800 sexually active women between age group of 25-45 years were screened by VIA/VILI. Screen positive women underwent colposcopic examination and directed biopsy, if required. Results: Among 1800 women, 171(9.5%) were screen positive. Of these 28 women(16.37%) were VIA positive, 40 women(23.39%) were VILI positive and 103 women(60.23%) were both VIA & VILI positive. 150 women underwent colposcopic examination, rest 21 women were lost to follow up. 92 women had abnormal colposcopic findings while 58 had normal findings. In the women who had abnormal colposcopy, 19 had inadequate colposcopy rest 73 women underwent biopsy. On histopathology, nonspecific cervicitis was found in 35 women (47.94%), metaplasia in 25(34.25%), CIN-1 in 10(13.70%) and CIN-2/3 in 3(4.11%). Sensitivity of screening methods was 79.35%, specificity was 75.32% and positive predictive value was 17.81%. Conclusion: Cervical cancer is the second most common cancer in women globally. Cervical cancer is a leading cause of cancer-related death among women in developing countries. As cytology-based screening is difficult to implement, in such low-resource settings hence, alternative low-cost and effective screening methods based on visual examination of the cervix that require simple equipment and relatively brief training have been explored for the control of cervical cancer in low-resource settings.