Single-visit approach of cervical cancer screening: See and Treat in Indonesia

Abstract

Background:We performed a cross-sectional study in Indonesia to evaluate the performance of a single-visit approach of cervical cancer screening, using visual inspection with acetic acid (VIA), histology and cryotherapy in low-resource settings.Methods:Women having limited access to health-care facilities were screened by trained doctors using VIA. If the test was positive, biopsies were taken and when eligible, women were directly treated with cryotherapy. Follow-up was performed with VIA and cytology after 6 months. When cervical cancer was suspected or diagnosed, women were referred. The positivity rate, positive predictive value (PPV) and approximate specificity of the VIA test were calculated. The detection rate for cervical lesions was given.Results:Screening results were completed in 22 040 women, of whom 92.7% had never been screened. Visual inspection with acetic acid was positive in 4.4%. The PPV of VIA to detect CIN I or greater and CIN II or greater was 58.7% and 29.7%, respectively. The approximate specificity was 98.1%, and the detection rate for CIN I or greater was 2.6%.Conclusion:The single-visit approach cervical cancer screening performed well, showing See and Treat is a promising way to reduce cervical cancer in Indonesia.

Managing the changing burden of cancer in Asia

“…Large-scale opportunistic screening with VIA is ongoing in routine health services nationally or regionally in Bangladesh [47], India [40], Indonesia [48] and Thailand [49]. Since screening programmes are not common, facilities for diagnosing and treating high-grade cervical intraepithelial neoplasia (CIN) using techniques such as colposcopy, cryotherapy, cold coagulation and loop electrosurgical excision procedure (LEEP) are extremely limited in many regions of Asia.…”

The Effect of Carbogen Breathing and Nicotinamide Added to Standard (Chemo)Radiation Treatment of Advanced Cervical Cancer in Indonesia

“…As a result, cervical cancer is often found at an advanced stage of disease. 3 Optimal treatment for advanced stages consists of a combination of radiotherapy (RT) and cisplatinum-based chemotherapy. 4 Chemotherapy, however, is not always available or is not administered because of medical reasons.…”

Cervical cancer prevention in Indonesia: An updated clinical impact, cost-effectiveness and budget impact analysis

“…In Indonesia, both Visual Inspections using Acetic Acid (VIA) screening and pap smear are available for free for 30-50 years old women in Community Health Care Center (Pusat Kesehatan Masyarakat-Puskesmas). Our base case implemented several cervical cancer screening profiles for Indonesia including 21% of screening coverage, 10% of detection rate [10]and 83% of cryotherapy coverage [11].…”