Cervical Cancer Screening Program in Bangladesh

Abstract

Background: Cervical cancer (CC) is the fourth most common cancer in women worldwide with an estimated 569,847 new cases and 311,365 deaths in the year 2018. In Bangladesh, the incidence of CC was 8068 and 5214 women died from CC in the year 2018.1CC constitutes about 12% of the female cancer in this country.1 Methods: The present situation of cervical cancer screening program is reviewed. Results: The Government of Bangladesh (GOB) adopted visual inspection of cervix with acetic acid (VIA) method for cervical cancer screening. The major strengths of VIA is its simplicity, low cost, potential for immediate linkage with investigations/treatment, feasible in low resource settings and the possibility of rapid training to the providers. The GOB has extended the program to all districts and selected upazilas.The screening programme has been implemented through capacity building of service providers of Medical College Hospitals (MCHs), District Hospitals (DHs), Mother and Child care Welfare Centers (MCWCs) and selected Upazila Health Compleses(UHCs) and several institutes.Service providersare performing VIA for the women of 30 years and above at about 417 VIA centres at primary, secondary and tertiary level health care facilities of 64 districts of Bangladesh. Screen positive cases are being referred to the colposcopy clinics of 14 government MCHs and BSMMU, where evaluation and management are carried out. From January 2005 to June 2017, 1647380VIA tests were performed at different facilities with 4.6%positivity.Among the VIA +ve women attending women at the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), 51% had precancerous or cancerous condition of the cervix, 3312 (14.10%) were treated by local excision, 2428 (10.30%)by local ablative method and1413 (6%) women with cervical cancer were referred to oncology. In Bangladesh, LEEPand thermal ablation has acquired acceptability as a commonly used treatment method for selected CIN and ‘see-and-treat’ approach for high grade diseases combining colposcopy and LEEP/ thermal ablation has been adopted since the year 2010 to improve compliance to treatment. Conclusion: Bangladesh has established VIA as screening test for prevention of cervical cancer in quiet a good number of facilities with wide coverage. But the program has to be expanded readily to prevent cancer and reduce sufferings & untimely death of women due to this devastating disease. Key word: Prevention of cancer cervix; prevention of cancer cervix in Bangladesh, VIA in Bangladesh. See & Treat of cervical cancer. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1): 63-73