Cervical cancer is the second most common cancer among women worldwide, accounting for 452,000 new cases per year. In many developing countries, where an estimated three-fourths of the world burden occurs, it is the most common cancer among women and the most common cause of death among middle-aged women. Despite its public health importance, there are no effective prevention programmes in most developing countries and hence the risk of disease and death from cervical cancer remains largely uncontrolled. Invasive cervical cancers are preceded by a long phase of precancerous lesions that can be detected by screening and treated effectively by simple treatments, which prevent invasive cancer. Cytology-based screening is effective, but beyond the capacity of the health services in many of these countries. Hence, other methods of early detection of cervical neoplasia, particularly those based on visual inspection, are being investigated.
Two simple, low-technology screening tests, namely visual inspection with acetic acid (VIA) and with Lugol’s iodine (VILI), which are based on the ability of the trained health-care personnel to detect acetowhite areas, or yellow non-iodine uptake areas, in the cervical transformation zone, are currently being evaluated in experimental settings as potential alternatives to cervical cytology. Published results show that VIA has similar sensitivity, but somewhat lower specificity when compared to quality cytology. For VILI, preliminary results from several studies in progress indicate that it is another promising screening test.
This manual is intended to help in the training of a range of health-care personnel such as health workers, nurses and physicians to perform VIA and VILI. Draft versions of this manual have been used over the last three years to train health care personnel in 22 training courses in the context of specific evaluation studies of cervical cancer prevention, supported by the Bill & Melinda Gates Foundation through the Alliance for Cervical Cancer Prevention (ACCP) in Angola, Burkina Faso, Congo, Guinea, India, Mali, Mauritania, Nepal, Laos, Senegal and Tanzania. Feedback from the participants in these courses and test providers has been particularly useful in revising several draft versions of the manual, which is expected to fulfil the long-felt need for a simple learning resource to provide proper and adequate training of health care personnel and to ensure skilled practice of VIA and VILI in experimental and clinical detection settings.
P. Kleihues M.D.
Director, IARC
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A Practical Manual on
Visual Screening for
Cervical Neoplasia
Edited by R. Sankaranarayanan
and Ramani S. Wesley
2003; 52 pages
80 color photographs
ISBN 92 832 2423 X
US$ 15
Cervical cancer is the second
most common cancer among
women worldwide, and this
book is a teaching manual on
VIA and VILI to train health
personnel, especially in developing
countries, with the aim
to detect this disease in the
early pre-invasive phase and
save women’s lives.
Two simple, low-technology
screening tests, namely visual
inspection with acetic acid
(VIA) and with Lugol’s iodine
(VILI) – based on the ability of
the trained health-care personnel
to detect acetowhite
areas, or yellow non-iodine uptake
areas, in the cervical
transformation zone – are
being evaluated as potential alternatives
to cervical cytology.
English . French
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Foreword