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APHA Scientific Session and Event Listing

John E. Varallo, MD, MPH, FACOG, Omni Med, c/o 1828 15th Street, NW, Washington, DC 20009, 202-234-6899, varalloj@gmail.com and Orrin Liddell, MBBS, Department of Obstetrics and Gynaecology, Georgetown Public Hospital Corporation, New Market Street, Georgetown, Guyana.

Purpose: Cervical cancer is almost completely preventable when precancerous lesions are detected and treated in a timely manner. Yet, cervical cancer continues to be a major public health problem for women in Guyana where, as in many developing countries, major logistical and technical barriers exist with traditional cytology-based screening. We conducted a pilot mobile cervical cancer prevention clinic to assess the feasibility, accuracy, safety, and acceptability of performing VIA with same-day treatment of screen positive women in Moruca, a remote Amerindian community in Guyana.

Data and Methods Used: All screening occurred at the mobile clinic in Moruca. Determination of VIA screen results followed a strict protocol, while processing of histopathology specimens took place at Guyana's main referral laboratory. Screening occurred in the mornings, followed by treatment in the afternoons/evenings of that same day.

Main Results: 100% (n = 72/72) of women received immediate results of screening, with a screen positive rate of 37.5% (n = 27/72). 100% (n = 27/27) of screen positive women received same-day treatment. Positive predictive value for cervical dysplasia (by histopathology) was 92% (n = 22/24). No major complications were reported. 100% of women screened and treated reported satisfaction with the services.

Policy Implications: VIA provides an opportunity to link screening with treatment in a single-visit, thus overcoming the large logistical barriers associated with traditional multi-step strategies. This low-cost, safe, effective and highly acceptable strategy is a practical alternative to dramatically expand coverage in low-resource settings such as Guyana.

Learning Objectives:

• Describe logistical and technical barriers associated with traditional cytology-based cervical cancer screening and prevention services.
• Identify and discuss an alternative evidence-based approach to cervical cancer prevention that is applicable for low-resource settings.
• Describe how visual inspection with acetic acid (VIA) can greatly expand coverage of cervical cancer screening in low-resource settings and how it builds local capacity.

Keywords: Cancer Prevention, Cervical Cancer

Presenting author's disclosure statement:

Any relevant financial relationships? No

Handout (.ppt format, 6926.0 kb)