To address the value of visual inspection where HPV-based screening is not yet available, we evaluated the real-world effectiveness of visual inspection with acetic acid (VIA) and with Lugol's iodine (VILI) as a primary screening method for cervical cancer in rural China.206,133 women aged 30-59 received two rounds of VIA/VILI screening for cervical cancer in 2006-2010. Women with positive screening results underwent colposcopy and direct biopsy, and treated if cervical intraepithelial neoplasia grade 2 or worse (CIN2+) were diagnosed. Clinical effectiveness of VIA/VILI was evaluated by process and outcome measures.The VIA/VILI positivity rate, biopsy rate and detection rate of CIN2+ in the second round were significantly lower than the first round. The two-year cumulative detection rate of CIN2+ varied from 0.53% to 0.90% among the four cohorts initiated in 2006, 2007, 2008 and 2009. The first round of screening detected 60% to 83% of CIN2, 70% to 86% of CIN3, and 88% to 100% of cervical cancer. Over 92% of CIN2+ were found at the early stage.Multiple rounds of visual inspection with continuous training and quality assurance could act as a temporarily substitutional screening method for cervical cancer in resource-restricted settings.This article is protected by copyright. All rights reserved.