Community screening of cancer Cx? Community screening :-Down staging of Cancer cervix,

Community screening of cancer Cx? Community screening :-Down staging of Cancer cervix,

A) Cytology based SCREENING Programme:-

Can Screening reduce the prevalence to 100%?

Can Screening reduce the prevalence to 100 Pap have good specificity 86-100%. Sensitivity is limited to 30-87%as often due to poor interpretation malignant cells are confused / reported as normal cells. Screening even done properly does not exclude the possibility of cancer CX.

What are the drawbacks of of Cytology based Screening Programme

1) Multiple visits==2) Lack of excess trained cytologists & 3) manpower, 4) Labour intensive, Expert cytologists, 5) Obtain reports and 6) then treating the CIN,--7) adequacy of smear, 8) Transport etc. 9)compliance of women,10) Most importantly in obvious cancer cervix as many as 50% cases of invasive Ca Cx will be Pap. Negative.

B) What do we mean by “Liquid Based Cytology (LBC) “-In this method à :-Small breakable tip brush where tip is broken in the liquid. Liquid is then filtered/ centrifuged then spread over the slide and stained.

a) Ancillary testing such as molecular testing is possible 2) low rate of unsatisfactory smear. So far as specificity and sensitivity is considered both traditional Pap and Liquid Based Cytology (LBC) are almost same specially for HSIL (high grade squamous intraepithelial lesions).

b) Drawbacks of LBC:- cost high, sophisticated instruments,,,

c) What is Automated Pap Smear/ AutoPap & AutoCyte Screen): At first slides are put to computer and material on the slides are reviewed by the computer first (shape, optical density of the cells) are judged by the computer. This computer selects some abnormal slides which mandate manual screening (.Re-screening).Manual review is essential when either cytologist or computer ranking informs something abnormal.

d) VIN(Visual Inspection of Methods):- Sensitivity 70-80% and specificity is 50-80% : SINGLE-VISIT APPROACH: cost effective, minimal training, Minimal Health Care infrastructure, Results are available immediately, for initiating Tr. No chance of “ lost to follow up”; Either add 3-5% of Acetic Acid(VIA) – cellular proteins coagulates- therefore cancer cells containg much protein looks more aceto white

Lugol’s Iodine (VILI). Normal cellular glycogen takes up iodine –Colour of normal cells containing glycogen-Mahogany brown or black.

The precancerous or cancerous lesions lack normal cancer and therefore unable to take up colour of iodine and look well defined areas of thick mustard color or saffron yellow areas. But not effective in postmenopausal women where Tr. Zone can not be seen properly.

VIAM (Performing VIA under magnification):-same sensitivity and specificity.

E)Community screening by VIA followed by tr in same visit at Hyderabad – 8 yrs. Follow up show 25% reduction of incidence of ca cx at the rate of 35% reduction in ca mortality. In 7 yrs follow up. Single round follow up does not help much.

F) Parallel Testing in community by VIA( acetic acid) & VILI(Lugols iodine) : And then supplement further test in suspicious cases only::- Thee is higher sensitivity of VILI than VIA:- Only when visual tests results are suspicious then go for cytology.& HPV testing if funds permit.

HPV infection: Most common viral STI, Requires cofactors like smoking, OCP, other STI, high parity, nutritional deficiency

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