Impact of visual inspection with acetic acid plus cryotherapy “see and treat” approach on the reduction of the population burden of cervical preinvasive lesions in Southeast Nigeria

Abstract

Objective: The aim of this study is to determine the impact of visual inspection with acetic acid (VIA) plus immediate cryotherapy on the prevalence of VIA‑detected cervical squamous intraepithelial lesion (SIL).
Methods: Women in four rural communities in Southeast Nigeria were screened with VIA. Women who tested positive to VIA were offered either immediate cryotherapy or large loop excision of the transformation zone based on predetermined eligibility criteria. Cervical biopsies were taken before cryotherapy and examined by consultant histopathologists. All participants were rescreened 1 year later. The main outcome measures were population prevalence of cervical precancers before and after intervention, cure rates, and over‑treatment rates.
Results: A total of 653 women participated in the study. The prevalence of cervical SIL before the intervention was 8.9% (58/653). The prevalence 1 year later was 1.4% (9/649). This gave an 84.3% reduction in the population prevalence of SIL. The reduction in cervical SIL prevalence was statistically significant (P = 0.0001). The prevalence of high‑grade SIL reduced significantly from 4.1% (27/653) preintervention to 0.5% (3/649) 1 year postintervention (P = 0.0001). This gave an 87.8% reduction in the population prevalence of high‑grade SIL. Cryotherapy provided a cure rate of 87.9% (95% confidence interval: 76.82–94.33).
Conclusion: Population cervical cancer prevention using VIA plus immediate cryotherapy leads to significant reduction in the population prevalence of cervical SIL. This has the potential of being an acceptable supplement to cervical cytology for cervical cancer prevention in low‑income populations.

Key words: Cervical cancer, cryotherapy, impact, see and treat, visual inspection with acetic acid