Visual inspection with acetic acid (VIA) for cervical screening
A nurse paints the cervix with household-strength vinegar and looks with a torch: precancer turns white within a minute and can be frozen or heat-treated at the same visit, which is how cervical cancer deaths were cut by a third in Indian villages without a laboratory.
Overview
What it measures. Dilute (three to five per cent) acetic acid makes abnormal cervical epithelium, dense with protein, turn opaque white for a minute or two while normal tissue stays pink. A trained nurse or health worker inspects with a bright light and classifies the cervix as negative, positive or suspicious for cancer. Lugol's iodine (VILI) is a variant. The test gives an answer while the woman is still on the couch, which is its whole point: eligible positives can be treated at once by cryotherapy or thermal ablation without a second visit that many women in rural settings never make.
Evidence. Cluster-randomised trials in India provide the evidence. In Dindigul district (Lancet 2007) a single round of VIA screen-and-treat in women aged 30 to 59 reduced cervical cancer incidence by a quarter and mortality by about a third over seven years. The Mumbai trial run by the Tata Memorial Centre, screening every two years with primary health workers, showed a 31 per cent fall in cervical cancer mortality after twelve years. The Osmanabad trial compared VIA, cytology and HPV testing head to head; only HPV testing reduced advanced cancers and deaths in a single round, which is why the World Health Organization now prefers HPV testing as the primary test, with VIA as a triage of HPV-positive women or as the primary test where HPV testing is not yet affordable.
Who should have it and what changes. The WHO 2021 guideline recommends HPV DNA testing from age 30 every five to ten years in the general population, with VIA acceptable as a screening test in programmes that cannot yet offer HPV testing, and as the visual step that decides whether an HPV-positive woman can be treated by ablation that day. VIA costs a few cents in consumables, but its accuracy varies greatly with the examiner's training and supervision, it performs poorly after the menopause when the transformation zone recedes, and it overtreats. AI-read cervical images from a phone camera are being developed to standardise it.
- Self-collected swab
- HPV virus DNA
- Cervix: colposcopy
- Negative: five years
How it works
Three to five per cent acetic acid coagulates protein in dysplastic cervical epithelium, producing transient acetowhite change visible to the naked eye, enabling same-visit ablative treatment of eligible lesions.
- Immediate result enabling same-visit treatment
- Minimal equipment and cost, deliverable by trained nurses
- Randomised evidence of lower cervical cancer mortality
- Accuracy depends heavily on training and supervision
- Poor performance in post-menopausal women
- HPV testing outperforms it where affordable
Latest papers
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Similar pages
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- PersonJade Goody
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- Key paperSelf-collected HPV samples are as accurate as clinician samples and reach women who never attend screening
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Shares Osmanabad cervical screening trial (HPV testing vs cytology vs VIA), HPV DNA testing and self-sampling, Tata Memorial Centre, International Agency for Research on Cancer (IARC / WHO).
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Shares World Health Organization Cancer Programme, HPV DNA testing and self-sampling, International Agency for Research on Cancer (IARC / WHO), HPV & HBV vaccination.
- PersonAndré Ilbawi
Shares World Health Organization Cancer Programme, International Agency for Research on Cancer (IARC / WHO), HPV & HBV vaccination, Cervical cancer.
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