Development of a visual inspection programme for cervical cancer prevention in Bangladesh.

Cervical cancer is the most common reproductive cancer in women in Bangladesh, and most women come for diagnosis and treatment when it is too late. To support early detection of pre-cancerous conditions and prevent cervical cancer, Bangladesh undertook a screening programme using visual inspection of the cervix with acetic acid (VIA) and cryotherapy through a public sector programme. The programme was launched in 2004-05 in a phased manner, starting with a pilot programme in 16 of the 64 districts in the country and scaled up to 44 districts as of the end of 2007. Evaluation of the pilot programme's performance showed that VIA can be carried out by trained doctors, nurses, and paramedical workers in Bangladesh, even though the level of resources is poor, and women, their partners and families are often not aware of the disease and its consequences. The programme now needs to move from opportunistic screening to population-based, systematic screening of women over age 30. More providers need to be trained, and clinics better equipped. The links between screening, diagnosis and treatment need to be improved and the false-positive rate of VIA tests greatly reduced. It is only when we have achieved high coverage that reduced rates of cancer can be ensured.