Abstract
BACKGROUND: This study was conducted to assess the effectiveness of visual inspection with acetic acid (VIA) followed by colposcopy for cervical cancer screening. Like many low- and middle-income countries (LMICs), Bangladesh struggles with inadequate cervical cancer screening and diagnostic facilities, as well as a shortage of cytopathologists and histopathologists in remote rural areas. Human papillomavirus (HPV) testing has not yet been implemented effectively in Bangladesh, and cytology (Pap smear) is a costly procedure. The current study performed VIA and colposcopy on apparently healthy adult women, primarily to screen for cervical lesions and, secondarily, to identify associated risk factors. METHODS: This cross-sectional study was conducted in a remote rural health center in Bangladesh using a straightforward and affordable approach: VIA followed by colposcopy. This facility-based, cross-sectional study included 384 married women aged between 18 and 65 years recruited after field-level awareness on cervical cancer prevention. RESULTS: Out of 384 women tested, 247 (64.3%) were adults, 85 (22.1%) were middle-aged, 33 (8.6%) were older, and only 19 (4.9%) were young adults. The study found that more than one-third of the participants (39.1%) engaged in sexual activities without using condoms. A total of 20 participants tested VIA-positive (5.2%), of whom 60% were confirmed by colposcopy. The chi-squared test identified multiple sexual exposures without condom use as a significant risk factor for cervical cancer. All double-positive cases (n = 12) received treatment; 7 (58.3%) underwent thermocoagulation (heat-based ablation), and 5 (41.7%) received a loop electrosurgical excision procedure (LEEP) at referral hospitals. CONCLUSION: We propose that, to achieve Sustainable Development Goals 3.7 and 3.8, VIA followed by colposcopy is suitable for screening cervical cancer in rural areas of Bangladesh and other LMICs, where screening techniques such as Pap smear and HPV tests are not yet widely available and accessible.