Prevention of cervical cancer: early detection of precancerous lesions of cervix in women from a marginalized environment


  • D. M. Christe National Institute for Research in Human Reproduction-Field Unit, Indian Council of Medical Research Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai, India
  • Anjalakshi Chandrasekar Department of Research, The Tamilnadu Dr. MGR Medical University, Chennai, India
  • K. Jayashree Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai, India
  • P. Meenalochani Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai, India
  • Shaanthy T. K. Gunasingh Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai, India



Colposcopy, Detection, Precancerous lesions cervix, Screening


Background: The objective of the present study was to find out the efficacy of low-cost methods, available for screening for cervical cancer and early detection of precancerous lesions, of cervix.

Methods: The study with power above 80%, was conducted over a period of almost three years. Women aged below fifty years were included in the study. A total of 100 women were diagnosed with cervical intraepithelial neoplasia (CIN) and 244 women with chronic cervicitis by histopathological examination reports. Ten women were HIV positive.   

Results: Low cost screening tests of visual inspection of cervix after application of 5% acetic acid (VIA) and visual inspection of cervix after application of Lugol’s iodine (VILI) were positive in 75% of women with CIN and in combination with colposcopy, positive in 93%. The diagnostic accuracy of colposcopy was highest at 86%. (Odds ratio-.48.79).

Conclusions: Initial screening for younger women with fewer years of exposure, the low cost tests, VIA / VILI  could be used under low magnification. Colposcopy should be done for all women with positive tests. The costlier human papilloma virus (HPV) tests should be done at cost effective purpose for high risk groups and when indicated, for early detection of precancerous lesions of cervix and prevention of cervical cancer.


Bobdey S, Sathwara J, Jain A, Balasubramaniam G. Burden of cervical cancer and role of screening in India. Indian J Med Paediatr Oncol. 2016;37(4):278-85.

Badwe RA, Dikshit R, Laversanne M, Bray F. Cancer incidence trends in India. Jap J Clinical Oncol. 2014;44(5):401-7.

Sreedevi A, Javed R, Dinesh A. Epidemiology of cervical cancer with special focus on India. Int J Women's Health. 2015;7:405.

India Against Cancer. Available at: cancer

Williams JH, Carter SM, Rychetnik L. ‘Organised’ cervical screening 45 years on: How consistent are organised screening practices? Europe J Cancer. 2014;50(17):3029-38.

Srinivasan S., Johari V., Jesani A. (2018) Cervical Cancer Screening in India. In: Schroeder D., Cook J., Hirsch F., Fenet S., Muthuswamy V. (eds) Ethics Dumping. SpringerBriefs in Research and Innovation Governance. Springer, Cham.

Human Papillomavirus and Related Cancers, Fact Sheet 2017. Available at:

Jain S, Agarwal J, Bhaskar J, Cervical Cancer Prevention: Update 2017 for Indian Gynecologists.

Sankaranarayanan R, Esmy PO, Rajkumar R, Muwonge R, Swaminathan R, Shanthakumari S, et al. Effect of visual screening on cervical cancer incidence andmortality in Tamil Nadu, India: a cluster-randomised trial. The Lancet. 2007;370(9585):398-406.

Poli UR, Bidinger PD, Gowrishankar S. Visual Inspection with Acetic Acid (VIA) Screening Program: 7 Years’ Experience in Early Detection of Cervical Cancer and Pre-Cancers in Rural South India. Indian J Community Med. 2015;40(3):203-7.

Nandakumar A, Ramnath T, Chaturvedi M. The magnitude of cancer cervix in India. Indian J Med Res. 2009;130(3):219

Swaminathan R, Shanta V, Ferlay J, Balasubramanian S, Bray F, Sankaranarayanan R. Trends in cancer incidence in Chennai city (1982-2006) and statewide predictions of future burden in Tamil Nadu (2007-16). National Med J India. 2011;24(2):72.

Bhattacharyya AK, Nath JD, Deka H. Comparative study between pap smear and visual inspection with acetic acid (via) in screening of CIN and early cervical cancer. J Mid-life Health. 2015;6(2):53.

Dijkstra MG, van Zummeren M, Rozendaal L, van Kemenade FJ, Helmerhorst TJ, Snijders PJ, et al. Safety of extending screening intervals beyond five years in cervical screening programmes with testing for high risk human papillomavirus: 14-year follow-up of population based randomised cohort in the Netherlands. BMJ. 2016;355: i4924.

Castro B, Ribeiro DP, Oliveira J, Pereira MB, Sousa JC, Yaphe J. Cervical cancer screening: age limits, frequency and ideal examination: review of recent evidence and compared to the performance indicator evaluated in Portugal. Cien Saude Colet. 2014;19(4):1113-22.

Berenson AB, Hirth JM, Chang M. Change in human papillomavirus prevalence among US women aged 18–59 years, 2009–2014. Obstetrics and Gynecology. 2017;130(4):693-701.

Obel J, Souares Y, Hoy D, et al. A systematic review of cervical cancer incidence and mortality in the Pacific Region. Asian Pac J Cancer Prev. 2014;15(21):9433-7.

Sullivan R. Affordable cancer care: A Global Mirage? Available at:

Goodman A. HPV testing as a screen for cervical cancer. BMJ. 2015;350:h2372.

Hussain SA, Sullivan R. Cancer control in Bangladesh. Jap J Clin Oncol. 2013;43(12):1159-69.

Sawaya G, Smith-McCune K. Cervical Cancer Screening Obstet Gynecol. 2016;127(3):459-46.

Franceschi S, Wild CP. Meeting the global demands of epidemiologic transition - the indispensable role of cancer prevention. Mol Oncol. 2013;7(1):1-13.

Campos NG, Tsu V, Jeronimo J, Mvundura M, Lee K, Kim JJ. When and how often to screen for cervical cancer in three low-and middle-income countries: a cost-effectiveness analysis. Papillomavirus Res. 2015;1:38-58.

Adamopoulou M, Kalkani E, Charvalos E, Avgoustidis D, Haidopoulos D, Yapijakis C. Comparison of cytology, colposcopy, HPV typing and biomarker analysis in cervical neoplasia. Anticancer Res. 2009;29(8):3401-9.

Raychaudhuri S, Mandal S. Current status of knowledge, attitude and practice(KAP) and screening for cervical cancer in countries at different levels of development. Asian Pac J Cancer Prev. 2012;13(9):4221-7.

Arbyn M, Fisher A, Martin‐Hirsch PP, Zhao FH, Qiao Y. Low cost versus other screening tests to detect cervical cancer or precancer in developing countries. Cochrane Database of Systematic Reviews. 2012(11).

Hartwig S, Baldauf JJ, Dominiak-Felden G, Simondon F, Alemany L, de Sanjosé S, et al. Estimation of the epidemiological burden of HPV-related anogenital cancers, precancerous lesions, and genital warts in women and men in Europe: Potential additional benefit of a nine-valent second-generation HPV vaccine compared to first generation HPV vaccines. Papillomavirus Research. 2015;01:90-100.

Bosch FX, Broker TR, Forman D. Comprehensive Control of HPV Infections and Related Diseases. Monograph Vaccine. 2012;30(5).






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