Globally, the Pap Smear Test is the preferred method for cervical cancer screening. In developing countries like India, cytology based screening programs are difficult to organise because of limited infrastructure, lack of trained personnel and resources. Not more than 25% of women at high risk are screened annually. Though the Pap Smear Test is less expensive and highly specific, sometimes there is the need for repetitive smears due to low sensitivity. The patients have to come for follow up visits too.

An alternative strategy called Downstaging has been suggested by WHO especially in developing countries with minimal resources. The objective is to recognise cervical cancer in asymptomatic women. Nurses and paramedical workers use an instrument called speculum to identify abnormalities in the cervix which are visible to the naked eye. They then refer the cases to higher centres where facility exists for treating such conditions.

Visual inspection with acetic acid (VIA) is another screening method. It involves naked eye inspection of cervix under bright light 1 minute after applying 3 to 5% acetic acid. The precancerous or cancerous areas appear acetowhite in colour due to the coagulation of proteins. It gives immediate diagnosis, requires minimal infrastructure and has the possibility of treatment at the same visit.

Another cost effective approach for screening is Visual inspection of cervix with naked eye after application of Lugol’s Iodine (VILI). The abnormal areas appear as thick mustard or saffron yellow because they do not take up Iodine due to lack of glycogen in the cells. Studies in Southern India and Mumbai have shown that screening using VIA and VILI  followed by treatment at same visit showed 25% reduction in cervical cancer incidence and 35% reduction in cervical cancer related deaths.

Self collection methods have been tried in rural areas utilising vaginal devices or tampons which collect the cervicovaginal fluid that can be analysed. Though not a substitute for conventional Pap Smear, it can be suitable in areas where access to healthcare is limited.
                  
All these alternative screening methods can have greater healthcare impact by reducing the cases of advanced cervical cancer and cancer related deaths in low resource settings.

*Inputs: Dr Bindhu K S,MD DGO,Senior Consultant,Obstetrics &Gynaecology,Hiranandani Fortis, Vashi 

*Image courtesy: © Thinkstock photos/ Getty Images