Diagnosing Premalignant Lesions of Uterine Cervix in A ResourceConstraint Setting: A Narrative Review

Abstract

Cervical cancer is an important public health problem whose prevention should be integrated in all existing primary health care and women's health programmes in Nigeria and other developing countries. Cervical cancer is the second most common female malignancy in the world and it is the leading cause of cancer related deaths among women in developing countries. Furthermore, developing countries account for 80% of global deaths from cervical cancer. Early cancer detection remains a vital strategy for disease treatment and prevention; therefore the need for routine cervical screening cannot be overemphasized. Given the scope of the cervical dysplasia problem in our country, coupled with the difficulties that have been encountered in many of our health centres when attempting to implement cytology-based screening and colposcopy/biopsy programmes which remains the gold standard, there is the need to find an alternative, low-resource screening option. In most developing countries, patients often present late with advanced cancer of the cervix. Given the difficulty of ensuring high quality cytology-based services in many settings coupled with the absence of colposcopy, visual inspection of cervix with acetic acid (VIA) is a promising option in the new approach to screening for precancerous lesion, especially for low-resource settings. The front line doctor (family physician) and other para-medical staff, including nurses and midwives, require easily implemented procedures and protocols to be able to identify early cervical dysplasia and allow measures to be undertaken to prevent progression to carcinoma.