Downstaging of cervical cancer

Globally cervical cancer is the fifth most common cancer and of estimated 460,000 new cases each year three quarters occur in developing countries. In India annually 16% of the world's total cases occur and only 5% are reported in the early stages. Downstaging is defined as a process of screening for cancer using clinical approaches for early detection of this disease. This is distinct from screening test and results in detection of the disease at a less advanced stage in the absence of screening. This experimental approach is applicable in developing countries where cytological screening is not possible in the near future. In this method paramedical staff trained for minimum period will be able to identify any abnormality including suspicious cervix and refer the case early to centres where facilities exist for treatment of premalignant and malignant lesions, including educating the women regarding risk factors, symptoms of the disease and prophylaxis. This experimental methodology recommended by WHO for developing countries like India has to be evaluated by monitoring various ongoing projects where visual inspection screening method is used. The results are collected which include feasibility, compliance, costing, referral methodology, difficulties in implementation, specificity, sensitivity, positive predictive value and drawbacks. The methodology of visual inspection and modified aided visual inspection, frequency and results of various studies in the Indian scenario is for recommendation of downstaging in MCH care. This is to be implemented in rural areas taking into consideration their cultural background and available infrastructure since cytology screening is not possible to cover even 20% of the existing cases in the near future.