Implementation of cervical cancer screening: A demonstration in a rural community of North India

Context: S trategies for implementation of cervical screening are the need of the hour while effective screening tests for early detection exist. Aim: To demonstrate the implementation of cervical cancer screening by aided visual tests in a North Indian rural community. Setting and Design: Cross-sectional study in a rural setting. Subjects and Methods: Baseline survey of community perspectives of screening and identification of eligible women of age 30-59 years was performed by Accredited Social Health Activists (ASHAs). Screening was targeted on 7604 women by the methods of visual inspection of cervix using acetic acid (VIA), by using lugol′s iodine (VILI) tests and by Pap test. Screen positives were referred to colposcopy and further management. Data on evaluation parameters was collected. Statistical Analysis: Screening test performances were assessed by sensitivity, specificity and positive/negative predictive values (PPV/NPV) for detection of histological CIN II+. Results: Study showed coverage of 65.6% of total eligible women (7604). Extent of agreement of visual testes (VIA/VILI) between nurses and doctor was 77.3-100%. Screen positivity rates by VIA, VILI and Pap were 9.7%, 13.5% and 2.6%, respectively. Screen positives turned up for confirmatory diagnosis were 78%. Acceptance of treatment was 76%. Screen positivity of VIA and VILI declined (P < 0.001) with increase in age. Sensitivity, specificity, and PPV of VIA were 59.0%, 92.3% and 3.6% and of VILI were72.7%, 89.6% and 3.3% respectively. NPV was 99% in all the tests. Conclusion: Implementation of screening by aided visual tests was successfully demonstrated through utilization of ASHAs for motivation, achievement of good coverage and good response in clinical management of screen positives.