**10. Conclusion**

**8. Screening for vaginal/vulva cancers**

138 Contemporary Gynecologic Practice

CP, 1992)

**cancer**

Vulva and vaginal cancers account for 7% and 2% of all gynaecological cancers in the United Kingdom in with 80% of them been squamous cell carcinoma and 60% of vulva and 68% of vaginal cancers occur in developing countries (WHO 2009). In Nigeria cancers of the vulva and vagina constitute 1.3% and 1.4% of all gynaecological cancers (Clement et al 2013). It is worthy of note that 40 % of all vulva and vagina cancers are attributed to Human Papilloma virus in the United States of America with HPV 16 the main aetiological agent (Wu X et al 2008,Saraiya et al 2008). In developing countries like Nigeria HPV 16 and 36 have been identified in most cases of vaginal /vulva cancer (Thomas et al). This identification of this etiological agents makes one of the modalities of screening HPV genotype screening a possibility in addition visual inspection with acetic acid for vulva lesions. However there is no consensus on the modality of screening of vaginal and vulva lesions but it is advised that careful examination of vulva/perineal lesions must be undertaken and a biopsy of suspicious lesions taken. Despite the absence of supporting data e expert opinion recommend that annual visual inspection for vulva/vaginal lesions can be undertaken as part of the screening(Crum

**9. Geographical variations in screening programmes in gynaecological**

Screening of gynaecological cancers is largely dependent on the cancer burden in the respective country with each country strategizing to reduce the burden. Before the 1940s there was a notable rise in the incidence and mortality associated with cancer such as cervical cancer necessitating the organization of organized screening programmes especially in the `Nordic countries which were largely nationwide and population based resulting in a near nation wide coverage. This was largely achieved by the direction of national resources aided by well-

Converse is the case in developing countries with limited resources competing for numerous challenges. The screening programmes of countries are largely opportunistic, poorly organ‐ ized and not entered on national coverage of the population. The obvious lack of political will on the part of the various Governments has also compounded this problem. Most times screening programmes in these countries are cost driven With governments relying on methods that are relatively less expensive though not necessarily ideal screening methods. The absence of suitable manpower to handle more complex screening methods make such methods unavailable for generality of the population. Thus screening for cervical cancer in developing are usually based on the traditional cytology using the spatula with its drawbacks already highlighted as opposed to liquid based cytology. Less expensive methods for screening such as VIA and cervicography are also used to meet up with the challenges of the draught of the challenges of the draught of histopathologist to analyse samples collected. The absence of histopathologists puts a lot on pressure on already burdened histopathologists resulting in

formulated policies by the respective Governments with resounding achievements.

Gynaecological cancer screening have been shown over the years to be life saving as exempli‐ fied by the have shown over the years to be life saving as exemplified by the experience of the Nordic countries as regard cervical cancer where the traditional PAP smears had been used with resounding success reducing incidence and mortality. Same can not be said of other gynaecological cancers were there is currently no consensus on the ideal screening tool. The use of tumour markers like CA 125 solely had not been shown to be good screening tool hence the need for multimodal approach in dealing with ovarian tumours with some still in clinical trials hence the need for the multimodal means for screening for ovarian cancer with some still in the clinical trial phase.
