cervical cancer screening

1. Screen
&
Treat
Dr
Kawita
Bapat

2.
Dr.
Kawita
Bapat
• MS FICOG
• Director Of One Centre For Gynecological Excellence
• Senior Practicing Obgyn At Indore
• One Day Hysterectomy Specialist
• FOGSI Affiliated Colposcopy Center
• Vice President (Elect) FOGSI,2021
• Organising Secretary, AICOG 2021, Indore
• President Indore Menopause Society
• Vice President AMPOG
• President MP Chapter Of Vaginal Surgeons
• Secretory MP IAGE
• Executive Member ISAR
• Executive Member IAGE
• Chairperson Breast Committee FOGSI 2016-18
• Past President OBGYN Society INDORE
• GOVRNING COUNCIL MEMBER ICOG
• Past President LIONS Club INDORE
• Award Winner Of Nayika Indore And Captain Of Industry
• bapatkawita@gmail.Com
• www.Onegynae.Com
• Bapat Hospital Bapat Choraha Sukhlia Indore
+919826055666

3. Single
Visit
Approach
to
Cervical
Cancer
Preven;on
• Screening
for
Cancer
Cervix
by
VIA
• Treatment
of
VIA
posi;ve
women
by
abla;ve
therapy
• Enables
treatment
at
the
same
visit
• Minimises
loss
to
follow-­‐up
• Effec;ve
in
low
and
middle
income
countries-­‐
recommended
by
WHO

4. What
is
a
Single
Visit
Approach?
Colposcopy
not needed
Involves
Colposcopy

5. Target Population
• Priority to be given to screening
women aged 30-49 years
• Screening even once in lifetime
beneficial
Screening Tests
• VIA/Cytology/HPV testing
• VIA is appropriate to use in
women whose TZ is visible(<50
years of age)

6. WHO guidelines
2013
Low resource countries
No colposcope

7. GOVERNMENT
OF
INDIA
GUIDELINES
FOR
SCREENING
OF
COMMON
CANCERS
2016

8. 2016

9. GOI
Guidelines
• Medical
Officers,
Staff
Nurses
&
ANMs
trained
in
examina;on
of
oral
cavity,
breast
examina;on
and
Visual
Inspec;on
with
Ace;c
Acid(VIA)
• VIA
+
>Cryotherapy
by
trained
LMO
at
PHC/
Gynaecologist
at
CHC/DH
• District
Hospital
Colposcopy,
LEEP
&
HPE

10. MoHFW
Guidelines
2016

11. VIA as Screening Tool
(FOGSI)

12. Eligibility
for
Cryotherapy

16. IS
SCREEN
AND
TREAT
EFFECTIVE?

17. Screen
&
Treat
?
Effec;ve
• South
African
RCT
conducted
by
WHO
• VIA+/HPV+
-­‐Immediate
Abla;on
• Treated
HPV
arm-­‐77%
reduc;on
in
CIN
3
lesions
• Treated
VIA
arm-­‐38%
reduc;on
in
CIN3
lesions
A randomized controlled trial. JAMA.
2005;294:2173–2181.
J Natl Cancer Inst. 2010;102:1557–1567

18. Screen
&
Treat
• WHO
study
in
South
India-­‐Trained
Nurses
• VIA
&
Abla;on
by
Cryotherapy
• 75%
of
eligible
women
accepted
the
treatment
at
the
same
visit
• 55.6%
had
CIN
on
histopath
• 0.5%
had
subclinical
invasive
ca
• Cryotherapy
90%
effec;ve
for
all
CIN,
70%
for
CIN
3

19. Do
Women
Accept
Screen
&
Treat?
• Women
who
decide
to
undergo
screening
–
immediate
treatment
acceptable
•
Cryotherapy
&
LEEP
acceptable
treatments
• Sa;sfied
with
Screen
&
Treat

20. Screen
&
Treat
Works!
Decline
in
Cervical
cancer
numbers
in
10
years
Task
shiging
to
nurses

21. Experience
of
a
‘Screen
and
treat’
program
for
secondary
prevenNon
of
cervical
cancer
in
UPar
Pradesh,
India
• From
May
2014
to
January
2017
• 10
ci;es
in
Ukar
Pradesh,
India
using
World
Health
Organiza;on-­‐recommended
‘screen
and
treat’
approach
for
cervical
cancer
preven;on
• Private
prac;;oners
involved
to
provide
affordable
cervical
cancer
screening
to
women
mobilized
by
our
community
health
workers
•
100
836
women
aged
between
30
and
60
years
were
screened
with
visual
inspec;on
with
ace;c
acid
(VIA)
• 5477
(5.4%)
were
VIA
posi;ve
• Treatment
with
cryotherapy
was
given
to
3735
(68.2%
• In
the
three
ci;es
that
piloted
the
program,
VIA
posi;vity
rates
significantly
declined
from
6.6%
to
4.0%
during
the
scale-­‐up
phase
• The
rates
of
cryotherapy
significantly
increased
from
66.8%
to
76.7
• Significant
decline
in
the
VIA
posi;vity
rates
during
the
scale-­‐up
phase
in
the
three
ci;es
that
par;cipated
in
the
pilot
phase
• Successful
engagement
of
private
prac;;oners
to
provide
affordable
cervical
cancer
screening
and
it
is
possible
to
replicate
it
in
other
states
in
India
as
well.
J. Obstet. Gynaecol. Res. 2019
Srivastava Shikha1, Joshi
Smita2 , Chaudhury
Nayanjeet1, Pathak Ruchi1,
Saxena Parul1, Mahajan Uma3,

22. See
(Colposcopy)
&
Treat
• Screen
by
VIA
• Refer
to
Colposcopy
• See
by
Colposcopy
• High
Grade
Lesion-­‐Treat
in
the
same
visit
by
excision
• 70%
accept
treatment
• Risk
of
overtreatment-­‐negligible
• Regularly
done
in
Bangladesh

25. Our
Guidelines
for
our
women

26. Together
WE
can
ELIMINATE
Cervical
Cancer
• 35,000
gynaecologists
• Screen
5
women
every
day
• 35,000x5
=1,75,000
women
screened
daily
• 5,25,00,000
women
screened
every
year
• (Women
in
25-­‐65
years
eligible
for
screening)
• TOGETHER
WE
CAN
ELIMINATE
IT
IN
ONE
YEAR!

28.
THANKS