Efficacy, Safety and Acceptability of Thermal Ablation (Thermocoagulation) as Treatment Option for VIA (Visual Inspection with Acetic Acid) Based Screen and Treat Approach for Cervical Cancer Screening programmeme: Experience at Tertiary Care Centre of Northern India

For solving the problems related to accessibility to cervical cancer services in Low middle income countries (LMICs) and for strengthening the screen and treat approach, WHO is looking for a more suited and feasible treatment modality for cervical precancerous lesions specially for LMICs. The present study was planned for analysing the efficacy, safety and acceptability (for provider and client) of thermal ablation (thermocoagulation) in VIA positive cervical lesions.

The present prospective interventional study was conducted in the department of Obstetrics and Gynaecology over a period of one year. Patients attending gynecological OPD who had VIA positive cervical lesions, were treated with thermal ablation after written informed consent. For the procedure single or multiple probe application were done according to the size of lesion, each application was for 40 s. For acceptability, international agency of research cancer (IARC) validated questionnaire was filled from every provider and client. Patients were followed for side effects immediately, at 6 weeks and at 6 months. Efficacy was determined by absence of VIA positivity after 6 months of treatment.

Total 643 women were screened with VIA in outdoor services at our Gynaecology department and 85 (13.2%) were VIA Positive. Majority (73.9%) of the providers felt that thermocoagulator was very easy to use. 84.8% providers were very satisfied with the probe length and shape of thermocoagulator. No interruption of procedure was reported by any of the providers Whilst performing thermal ablation on all the 80 women. Majority of the patients (78.3%) had no complaints during/after the procedure. At 6 weeks, 71.1% women were asymptomatic. The commonest complication was watery vaginal discharge which on examination was non foul smelling. At 6 months most women were asymptomatic and efficacy of the procedure was 95.8%.

Thermal ablation is an option for treatment of cervical precancerous lesions in context of screen and treat programme in LMICs in terms of good provider and client acceptability, high efficacy and very few side effects.