Evaluation of See& Treat Approach for Urban

7/31/2019 Evaluation of See& Treat Approach for Urban

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Dr.Asha Jain 1

Dr. Asha JainM.D., D.N. B. (OBGYN)

Medical Director-Cancer Prevention & Relief Society (C.G.)Sri Srimaa Sharda Stree Cancer Suraksha & Anusandhan

Kendra, Raipur

58,Jalvihar Colony, Raipur (C.G.) 492 001

[email protected]


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Dr.Asha Jain 2

Evaluation

of

See & Treat Approach

for

Urban Slum Dwellers in a Camp

as a Preventive measure to Control the

Incidence of Cancer Cervix in the state

of

CHHATTISGARH


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Introduction

In the three CancerHospitals of Chhattisgarh,nearly 2000 women presentwith late stage InvasiveCarcinoma of Cervix every

year. Most of these women come

from the BPL group and areunable to afford treatment.

It is an established fact thatInvasive Ca Cervix ispreceded by CIN which hasa long duration.


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If CIN is diagnosed and

treated in time progression

to invasive disease can be

prevented in a largepercentage of cases.

We have been doing camps,

awareness programs and

Colposcopic Camps for thepast 5 years, to create

awareness about the

preventability of the disease,

thus trying to have an

impact on the incidence of

the disease by motivating

women to come forward by

themselves for screening.


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Method

With the help of the Motherand Child Health Dept. wegot an order asking theAnganwadi workers to

cooperate with us to getpatients for the camp.

105 workers were asked tofetch 2 women each. Thecriteria given them were-Married, 30 years or above orsymptomatic irrespective ofage & women not in mensesbut exclusively from slums.


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294 registrations

259 women examined 35 women unfit or

unwilling for examinationsdue to either Menses, longwait or child crying etc.

Detailed History-Menstrual, Sexual,Obstetric, Medical,Addictions

Complete examination-

WeightHeight,Blood PressureBreastsP/Abdomen


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Per Speculam examination

Per Vaginum examination Video Colposcopy with image

capture

Pap Smear

HPV HC2 Sampling in womenwith Acetowhite Lesions &Erosions bleeding on touch.

Procedures done -Invasive lesions - Biopsy

Acetowhite lesions - LeepBleeding erosions

Cryo Cautery /

Electric Cautery


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OBSERVATIONS

Complaints No. %

White discharge 92 35.52%

Post coital bleeding 11 4.24%

Irregular bleeding 5 1.93%

Backache 156 60.23%

Abdominal pain 121 46.71%

Dysuria 37 14.28%

Postmenopausal bleeding 4 1.54%

Other 20 7.72%

Distribution as per Presenting Complaints N=259


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Parity No. %

Distribution as per Parity N=259

0 23 8.88%1 20 7.74%

2 47 18.14%

3 89 34.36%

4 45 17.37%

5 22 8.49%

6 8 3.08%

7 2 0.77%8 2 0.77%

9 0 0.77%

10 1 0.38%


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Procedures Done

Pap smear 254

Colposcopy 259 100%

Leep / Biopsy 16 6.177%

Cryo 16 6.177%

Procedure No. %


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Colposcopic Diagnosis Final Diagnosis

Table for accuracy of Colposcopy N=259

Unsatisfactory 8 3.08% 8 3.08%

Satisfactory 251 96.91% 251 96.91%

Normal Cervix 194 74.90% 193 74.90%

Cervicites with Ectropion 19 7.33% 18 7.33%Cervicites 19 7.33% 20 7.33%

LGSIL 5 1.93% 6 1.93%

HGSIL 4 1.54% 4 1.54%

Metaplasia 2 0.77% 2 0.77%

Invasive Cancer 6 2.316% 6 2.316%

Papilloma of Cervix 1 0.386% 0 0.00%

Tuberculosis 0 0.00% 1 0.386%

Follow up Cancer Cervix 1 0.386% 1 0.386%

No. % No. %


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Report No. %

Reports of Pap Smear

Normal 75 29.52%

Atrophic 18 7.08%

Chronic non specific cervicites 144 55.59Koilocytosis 1 0.39%

Chronic NSC with koilocytosis 3 1.18%

CIN I 9 3.54%

CIN II 2 0.78%

Invasive 1 0.39%

Tuberculosis 1 0.39%


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Colposcopy HPE Final Diagnosis

Comparison of Colposcopy with HPE report N=16

Invasive 6 4 6

Metaplasia 0 1 1

Tuberculosis 0 1 1

CIN 9 10 8

Papillary growth

cervix

1 0 0


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Report Pap % Colposcopy % HPV % HPE %

Smear N=259 N=30 N=16N=254

Comparison of Pap Smear, Colposcopy, HPV & HPE

True +ve 12 4.72% 15 5.79% 7 23.33% 13 81.25%

False +ve 1 0.39% 1 0.38% 3 10% 0 0.00%

Falseve 3 1.18% 1 0.38% 4 13.33% 1 6.25%

True -ve 238 93.70% 243 93.82% 16 53.33% 2 12.5%


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Statistical Results

Value Pap Smear Colposcopy HPV HPV

N=254 N=259 N=30 N=259Sensitivity 80% 93.75% 63.63% 63.63%

Specificity 99.58% 99.75% 84.21% 98.71%

PPV 92.30% 93.75% 70% 70%

NPV 98.75% 99.59% 80% 98.79%

% of FN 20% 6.25% 36.36% 36.36%

% of FP 0.418% 0.40% 0.15% 1.20%


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Conclusion When we evaluate a

modality for decreasing theincidence of disease the twomost important criterion arethe % of false negatives and% of false positives.

The false negatives wouldescape being treated and thefalse positives would beover treated.

In Colposcopic

See & Treat-

-The % of false negatives is6.25% though the no. isonly one case.

-This was a case of severelyinfected cervical erosionand Cryo had already been

done..


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The false positives are thecases which would undergounnecessary biopsy or leep.-Here the percentage is only

0.40%, the one casediagnosed as squamousmetaplasia withkoilocytosis.

But through this approachall 14 women with CINlesions were managed, thuspreventing progress toinvasive cancer in at least50% of them.

Thus Quality Controlled

Colposcopy with treatmentby See & Treat approachis an effective method toprevent cancer cervix in ourcountry as seen by this pilot

study in Chhattisgarh.


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Acknowledgements

Institutions-

Department of Mother & Child Health (C.G.)

- Cancer Prevention and Relief Society(C.G.)

- Sri Srimaa Sharada Stree Cancer Suraksha&Anusandhan Kendra, Raipur.

- Balaji Nursing Home, Raipur.

- Gentech Diagnostics- New Delhi

- Micron Labs-New Delhi


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Individuals-

-Dr.P. Agrawal-Dr. Pratima Chaudhary

-Dr. Dinesh Gupta

-Dr.R.N. Verma-Mr. N.L.Chaudhary

-Members of CPRS (CG)

-Paramedical Students

-Anganbadi Workers

- All Staff


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Evaluation of See& Treat Approach for Urban

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