What’s Visual Inspection with Acetic Acid (VIA)?

August 22, 2018

Cervical cancer was one of the major causes of cancer death in American women. That’s changed with the widespread availability of cervical screening. When caught early, cervical cancer is often highly treatable. 

Unfortunately cervical cancer screening isn’t always offered. This is very true in most developing nations, and in areas with few monetary resources for clinical testing and treatment.

Pap smears are regarded as the golden standard of cervical screening. Unfortunately, they require skilled practitioners and very good laboratories to be effective. HPV tests are great at identifying women at risk for cancer. However, they don’t actually diagnose cancer and come in a non-trivial expense. That is the reason why physicians have developed a test called visual inspection with acetic acid (VIA). It’s cheap, simple, and powerful. 

What is Visual Inspection with Acetic Acid?

Visual Inspection with Acetic Acid, or VIA, appears to be a scary way to check for cervical cancer. In reality it’s rather straightforward. HPV tests look for HPV DNA, and need skilled technicians. Pap smears looks for small cellular changes in the cervix, and require a trained pathologist, VIA makes it possible for doctors to immediately see lesions along with also other changes in the cervix which are large enough to, presumably, need therapy.

The VIA process is quite straightforward.

The medical care provider simply swabs vinegar, i.e. acetic acid, on the cervix. They then look for areas that change colour. Regular cervical tissue stays unaffected by the acetic acid. . In contrast, damaged tissue — such as that found in cancerous or bronchial tumors — turns white. The supplier can then remove the damaged tissue onto the spot using cryotherapy or alternative techniques.

They can also carry out a biopsy for additional follow-up.

Most studies have found that VIA, and its cousin VLI — visual inspection with Lugol’s iodine — are somewhat less specific than Pap smears, but more sensitive. In plain terms, so they generally detect more early lesions but are also more prone to false positives. This could possibly result in over treatment. In low-resource areas where substantial numbers of women are still dying of cervical cancer, some authorities have decided that is a worthwhile trade-off.

In general, VIA seems to be an excellent cervical cancer screening method for use in low-resource settings. It works well in situations where Pap smears and HPV tests are inappropriate due to lack of expertise or large per-test price. The overall consensus is that VIA is just as helpful as the Pap smear. It is just a matter of determining which one is more appropriate in any particular circumstance. This is based upon the financial situation as well as the availability of trained personnel for screening and follow up.

It’s also worth noting that VIA has an advantage for traditionally under-served patients who may have difficulty coming in for follow-up maintenance. WIth VIA, treatment and screening are done in precisely the same visit.

There is not any need to await results and return to the doctor. There are various folks in the world for whom getting to the physician requires enormous amounts of time, cost, and negotiation. For them having the ability to take care of screening and therapy in a single trip can significantly lessen the personal and financial burdens of health care.