"Evaluation of the Visual Screening Method with Acetic acid and Lugol's Iodine for Effective Implementation with Local Health Care Providers and for Accuracy as a Cervical Cancer Screening Tool in Senegal"
According to the International agency for research on Cancer and the World Health Organization, approximately 80% of the cervical cancer cases in the world occur in developing countries (1). In Senegal, cervical cancer is the number one cancer killer of women followed by breast cancer. Because cervical cancer typically has a long pre-invasive state of about a decade or more and treatment at this state is highly effective at preventing progression to malignancy, establishing a cervical cancer screening program which detects the pre-invasive lesions followed by treatment is important in drastically reducing the current mortality and morbidity from cervical cancer as has been proven by such programs in developed countries. Unfortunately, over 80% of cervical lesion cases present as state III or state IV invasive cancer in Senegal. The reason behind this can be attribute to the high resources, personnel, training and infrastructure necessary to conduct local pre-invasive cervical cancer screening according to current protocols, the lack of knowledge and training on cervical cancer prevention and screening by local health care providers as revealed by this study and finally, through a dimension that is informally explored in this project which is the cultural inclination to avoid any form of gynecological exam under asymptomatic conditions and for as long as possible and the preference of traditional medicine until this fails.
The standard protocol for cervical cancer screening begins with a papanicolau smear, which requires trained pathologists and cytologists for interpretation that are not present in most regions of Senegal. It is followed by a colposcopy, which requires expensive equipment and training of personnel, again which are only available in very select areas and cone biopsy which requires surgeons and adequate facilities. Here we consider the analysis and evaluation of an alternative procedure, the visual inspection, which will require minimal resources and training in local resource poor areas, while limiting the cost demanding portions of the screening and treatment to the few facilities capable of such activities in Dakar. This procedure is analyzed for specificity, sensitivity and general effectiveness of the implementation by direct comparison to a pap smear, colposcopy, and a cone biopsy and histology. After the establishment of a screening method that is accurate and usable in resource poor areas such as Senegal, health care providers must be available and trained to screen the approximate two million women of child-bearing age for effective control of cervical cancer rates. Because it is not reasonable to expect the very few physicians in Senegal to deliver such screenings as it is the case in developed nations, we explore here the possibility of teaching the method to other local health care providers, such as midwives, and evaluate its accuracy when practices by novice care givers. We conducted these preliminary analyses in a small area outside of Dakar, called Yembeul, as a pilot study.