**Q.** Is there data to support combined visual inspection of the cervix
with acetic acid wash (VIA) in low resource settings?

**A.** Yes, there is a significant body of literature to support VIA

**Cervical Cancer Screening in Low Resource** **Settings**

**Combined visual inspection of the cervix with acetic acid wash (VIA)**

[INTERPRETATION:]{.underline} A single-visit approach with VIA and
cryotherapy seems to be safe, acceptable, and feasible in rural
Thailand, and is a potentially efficient method of cervical-cancer
prevention in such settings.

Gaffikin L et al Safety, acceptability, and feasibility of a
single-visit approach to cervical-cancer prevention in rural Thailand: a
demonstration project. Lancet. 2003 Mar 8;361(9360):814-20.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12642047&dopt=Abstract>

[CONCLUSION:]{.underline} Clinical history-taking could provide the
basis for patient triage to increase the clinical utility of VIA. Such
an approach could also serve to prioritize who gets tested first in
low-resource countries with high disease prevalence that are struggling
to strengthen national cervical cancer prevention programs.

Gaffikin L, et al Risk factors as the basis for triage in low-resource
cervical cancer screening programs. Int J Gynaecol Obstet. 2003
Jan;80(1):41-7.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12527459&dopt=Abstract>

[CONCLUSIONS:]{.underline} Well-organized screening programs can reduce
cervical cancer mortality in less-developed countries at low costs.
These cost-effectiveness data can enhance decision-making about optimal
policies for a given setting.

Mandelblatt JS, et al Costs and benefits of different strategies to
screen for cervical cancer in less-developed countries. J Natl Cancer
Inst. 2002 Oct 2;94(19):1469-83.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12359856&dopt=Abstract>

[CONCLUSION]{.underline}: Based on photographs of the cervix taken after
acetic acid wash, the level of agreement among raters using visual
inspection with acetic acid categories was moderate to substantial,
consistent with other commonly used tests

Sellors JW, et al Assessment of the cervix after acetic acid wash:
inter-rater agreement using photographs. Obstet Gynecol. 2002
Apr;99(4):635-40.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12039126&dopt=Abstract>

[CONCLUSIONS:]{.underline} For programs with limited resources but with
the capacity for HPV testing, sequential testing involving the use of
VIA followed by HPV could yield fewer false positives than the use of
VIA alone at a cost of relatively few additional false negatives.

Blumenthal PD, et al Adjunctive testing for cervical cancer in low
resource settings with visual inspection, HPV, and the Pap smear. Int J
Gynaecol Obstet. 2001 Jan;72(1):47-53.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11146077&dopt=Abstract>

In these cost-conscious times, a significant number of articles address
the cost-effectiveness of these technologies and the real value of
cervical cancer screening. This article reviews the current literature
concerning both the advent of new cervical cancer screening technologies
and the rediscovery of old ones.

Soler ME, Blumenthal PD. New technologies in cervical cancer precursor
detection. Curr Opin Oncol. 2000 Sep;12(5):460-5.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10975554&dopt=Abstract>

Recent evidence indicates that, depending on local conditions and
locally-made decisions, visual inspection of the cervix with acetic acid
wash, coupled with a benign form of therapy, such as cryotherapy, could
hold promise as a means of testing and treatment. By adapting
resource-appropriate technologies and building local consensus regarding
clinically driven public health approaches that are safe and feasible,
the challenge of reducing the mortality from cervical

Soler ME, Gaffikin L, Blumenthal PD Cervical cancer screening in
developing countries. Prim. Care Update Ob Gyns. 2000 May
1;7(3):118-123.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10840215&dopt=Abstract>