Prevention of cancer cervix: developing a task force

Background: Cancer cervix is the most common cancer in women of the developing countries where screening facilities are inadequate. Cancer cervix is a preventable cancer due to its long pre invasive stage and availability of screening methods. Colposcopy is an in situ clinical examination of cervix with magnification and illumination. It is a clinical method that complements the laboratory method of cytology in identifying the site of origin of dysplastic cells. Developing a task force for prevention of cancer cervix requires training of medical and paramedical staff. Methods: The study was conducted as a one-day live demonstration workshop on screening of cancer cervix in the department of obstetrics and gynecology in Saveetha Medical College, Chennai. Colposcopy Reid’s index calculation was demonstrated on twelve women. Sixty-four medical and paramedical health workers identified the pre-invasive lesion under magnification and green filter application. Acetic acid and Lugol’s iodine staining was done. Pretest and posttest helped the teaching faculty to assess the level of competency achieved. Results: The colposcopy-training workshop equipped the health workers to detect and treat the preinvasive cancers. Primary prevention by elimination of risk factors and HPV vaccination is difficult and expensive but secondary prevention by means of mass screening and treatment of precancerous lesion can reduce the progression to cancer cervix. The strategy, however is not to lower the incidence of cancer cervix, but to minimize cancer death due to early detection. Conclusions: A women with a preinvasive lesion of cancer cervix can be asymptomatic. This requires a task force for mass screening of all women in the community. Community health workers begin screening of all women from 21 years onwards with Pap smear and colposcopy. The trained heath workers can be used for downstaging of cancer cervix leading to a dramatic reduction in the incidence of invasive carcinoma. Even when a colposcopist detects the invasive carcinoma, it is so early that an 85-100% five-year survival rate can be achieved.