VIA has demonstrated high sensitivity for detecting CIN and cervical cancer. VIA has the advantage of requiring only low-technology equipment and the result is available within a couple of minutes. Among developing countries that usually have low resources, however, Pap smear programs are complex and costly to run and have failed to reach a significant proportion of women. Even under ideal conditions, false-negative rates for pap smear as high as 29 percent have been reported. It has been estimated that in India, even with a major effort to expand cytology services, it will not be possible to screen even one-fourth of the population once in a lifetime in the near future (ICMR 2001). VIA have several screening advantages – minimal requirement of infrastructure and equipment, immediate result, preliminary screening of high risk cases for referral and, not the least, it can be performed by trained paramedical workers.
VIA is the screening method that you can cover vast majority of risk women,espc women wge 30-45 . It is the PUBLIC HEALTH approach, it yield between 8-12% VIA positive which can be treated with simple procedure like cryotherapy. Once you found some case that can not be treated early, you can send for colposcopy.
VIA is very cost effectiveness, among the screening programs.
It represents a proven , simple means of identifying cervical intra epithelial neoplasia in developing countries.
As it have already been said here, both pap smear and VIA have their pratice limitations and owns difficulty to execution as their false positive and false positive, so there is no ideal methods for all cases.
So, I understand pap smear as an ideal screening method for patient on routine appointment when her has not cervical alterations once in my opinion we shouldn't exagerate in exams application if there is no suspection or motif for that under penalty of to provoque unneeded patient expectation and seizure.
LIke this I prefer to colect pap smear and wait its result to continue or not with other procedures.
At present , there are three reliable screening technics , Pap smear , VIA and HPV DNA test with different specificity and sensitivity . Depending on the availability of one's fund and policy, you can choose the proper one for your area . If you are dealing with women those live in remote area, no cytology tecnicians nor pathologists , no money for travelling,no time to go back and forth and wait for the results. I believe the procedure that can save the women live is the best , espc to be screened once in her life time.
Based on systematic reviews and metanylisis and taking account some facts:
1. Among those newly diagnosed with cervical cancer, 30–60 % have never had a screening test. (1)
2. Up to 15 % have had inadequate follow up after an abnormal Pap smear.(1)
3. 60 to 80 % of women diagnosed with advanced cervical cancer have not had a screening test within the past 5 years. (1)
4. The population-level impact of screening (i.e., reduction in the incidence and mortality of cervical cancer) was most influenced by the level of coverage. (2).
It is evident that due to the already established relationship between high-risk oncogenic HPV and cervical cancer, the possibility of primary screening using HPV DNA test, specially in places where cytology has not been used or where, for some reason , has not been adopted appropriately is very cost-effective. (3)
1- Glick et al, 2012
2- Goldie et al, 2006
3- Luhn ; Wetzensen, 2013
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