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One- year follow- up of single- visit approach to cervical cancer prevention based on visual inspection with acetic acid wash and immediate cryotherapy in rural Thailand
  1. B. Chumworathayi*,
  2. S. Srisupundit,
  3. P. Lumbiganon* and
  4. K. K. Limpaphayom
  1. *Khon Kaen University, Khon Kaen, Thailand;
  2. Thai Gynecological Cancer Society, Bangkok, Thailand; and
  3. Chulalongkorn University, Bangkok, Thailand
  1. Address correspondence and reprint requests to: Thai Ministry of Public Health Ethics Review Committee Approval Date: October, 22, 1999. This study is a part of “ Safety, acceptability, and feasibility of a single-visit approach to cervical cancer prevention in rural Thailand: a demonstration project” by “ Royal Thai College of Obstetricians and Gynaecologists (RTCOG)/JHPIEGO Corporation Cervical Cancer Prevention Group,” that was published in “ Lancet 2003; 361
    : 814–20,” and was presented in the Ninth Biennial Meeting of the International Gynecologic Cancer Society (IGCS), October 20–24, 2002, Seoul, South Korea, by Clinical Professor Somkeart Srisupundit. Abstract of this article was also previously published in International Journal of Gynecological Cancer 2002; 12:


The aim is to evaluate 1) the visibility of cervical squamocolumnar junction (SCJ) after cryotherapy treatment and 2) to evaluate the effectiveness of cryotherapy treatment originally performed as part of a safety, acceptability, and feasibility (SAFE) demonstration project evaluating the SAFE of visual inspection with acetic acid (VIA) followed by immediate offer of cryotherapy among those who were tested positive and eligible for treatment. A total of 704 women presented at 1-year follow-up exam during which VIA was performed again by nurses. Six hundred and forty eight (92.0%) women received colposcopy and any kind of biopsy, if indicated, by trained physician colposcopists at a referral hospital. At 1 year, VIA nurses assessed 42 of 648 referred women (6.5%) as abnormal (test positive or suspected cancer). The SCJ was visible to the colposcopists in 91.7% (594/648) of the women. Among 42 women assessed as abnormal by the nurses, colposcopic findings were abnormal in 83.3% (35/42), with one low-grade squamous intraepithelial lesion, two high-grade squamous intraepithelial lesion (HSIL), and one adenocarcinoma confirmed later by biopsy. Among 606 VIA negative women, colposcopy was abnormal in only 23.4% (142/606), with two cases of HSIL confirmed later. Given that the SCJ was visible in the vast majority of women (91.7%) after cryotherapy, VIA could be used to provide follow-up for women previously treated. The disease negative rate after cryotherapy (no human papillomavirus infection, no cervical intraepithelial neoplasia, and no cancer) at 1 year after treatment was 85.5% (554/648).

  • cervical neoplasia
  • colposcopy
  • cryotherapy
  • VIA
  • visual inspection with acetic acid

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  • Bandit Chumworathayi, MD, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. Email: bchumworathayi{at}