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  • 1. Comparison of visual inspection using acetic acid[VIA] and pap smear as a method of cervical cancer screening in low resource settings and prevalence of cervical cancer in diseased population
  • 2. • Carcinoma of cervix is the second most common cancer among women worldwide. Worldwide carcinoma of cervix accounts for about 500,000 new diagnosis and 273,000 deaths every year. Of the new cases 80% occur in the underdeveloped countries[1] • The pap smear remains the most common screening test for cervical cancer, however many developing countries do not have ample resources to implement cytology based prevention programmes[2] • An alternative of pap smear, a low cost test, visual inspection using acetic acid(via) has emerged for use in low resource settings where it can be performed by trained health professionals[3] • Cervical cancer is preventable condition and with well organized cervical cancer screening programmes, a major impact can be made on the incidence of and mortality from ca- cervix[4]
  • 3. • According to a study the invasive caner of cervix is the third commonest malignancy among female population of Pakistan[5]. By the time most patients appear to hospital the cancer has already advanced to stages two or three[6] • Objectives • 1] comparison of efficacy of VIA and pap smear as a method of cervical cancer screening in low resource settings • 2] to determine the proportion of women screened positive with VIA and screened positive with pap smear • 3]To compare the sensitivity, specificity, positive predictive value and negative predictive value of VIA and pap smear • 4]To determine the total number of CIN and CA-Cervix in the study population
  • 4. • Cervical cancer is very common among females of Pakistan and also it presents at advanced stage, in spite of that there is no affective as well as cost effective screening programme in our country.pap smear is used in many developed countries of the world as a screening test but difficult to imply in our country because of its cost, time required for interpretation of results and poor patient compliance. So in these circumstances VIA seems to be a better choice which is cost effective, results available immediately and no need of follow up by patient. Studies have done at international level that have also showed VIA as an affective screening approach in less developed countries(7,8). Only one such study has been done at lady wellington hospital Lahore , but it is first kind of this study in my institute and it will help develop better screening strategy in low resource settings of Pakistan as it is cheap, acceptable to the patient, immediate availability of the results and no need of patient compliance
  • 5. • Inclusion criteria o -age 25-60 years o Non pregnant o Multiparous o having history of persistent vaginal discharge, suspicious looking cervix, post coital bleeding, intermenstural bleeding • Exclusion criteria • • • • Pregnancy abnormal uterine bleeding absent cervix e.g. having underwent TAH Having visible gross cervical lesion of suspected malignancy
  • 6. • Operational definitions 1. Visual inspection with acetic acid(VIA) It will be performed by applying 5% acetic acid solution to cervix with a cotton swab and interpreting the findings 1 minute after application by visualizing the cervix VIA positive;- if a well defined dense opaque acetowhite lesion close to the squamocolumnar junction or acetowhite area close to the transformation zone is observed , the result will be labeled positive VIA negative;- the result will be labeled negative if • No acetowhite lesion • Faint and bluish white translucent acetowhite lesion • White line indicative of squamocolumnar junction(SCJ)
  • 7. • 2]Pap smear • It is a screening test for cervical cancer and involves taking scraping of cervical surface • I will perform this test when my patient is not menstruating ideally 2 weeks after day of her last menstrual period and will advise her not to use any vaginal medication 24 hrs before examination • I will put my patient into lithotomy position, insert the speculum, visualize the transformation zone. then insert the Ayres spatula, rotate it to 360 degree and take sample from transformation zone. After removing spatula sample will be evenly spread on slide and fix with an aerosol fixater before it gets dried and send for cytological examination • Positive smear results;- I’ll use BATHESDA reporting system to interpret the results
  • 8. • 3]Bathesda reporting system(7) • The classification uses the term • ‘squamous intraepithelial lesions’(SIL) to encompass all grades of CIN (cervical intraepithelial neoplasia) ,it is subdivide into two categories Low grade; which includes cellular changes associated with human pappiloma virus(HPV) infection and CIN-1 High grade; which includes CIN2 and CIN3 • Atypical squamous cells have two categories atypical squamous cells of undetermined significance(ASC-US) and atypical squamous cells that can not exclude high grade(ASC-H)
  • 10. • Material and methods • study design;- cross sectional/ comparative study • settings;- department of gynae and obs., PMC affiliated hospital Dhq . FSD • Duration;- minimum of 6 months after approval of my synopsis • sample size;- by using WHO sample size calculator for 2 poportions
  • 11. • Data collection procedure After taking consent from the hospital ethical review committee women attending outdoor department fulfilling inclusion criteria will be included in the study and informed consent will be taken from the patient. Exclusion criteria will be strictly followed to limit confounding variables. Demographic information will be collected in computer based database. History, general physical examination will be performed by me ,then I’ll put my patient in dorsal position and perform gynecological speculum examination. First I’ll take pap smear and then 5% acetic acid will be applied on cervix using cotton swab. The test results will be divided into 2 categories VIAnegative and VIA-positive. All the data will be collected and recorded by me on Performa attached at the end Data analysis procedure