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New Evidence on the Impact of Cervical Cancer Screening and Treatment Using HPV DNA Tests, Visual Inspection or Cytology

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A study published by Sankaranarayanan et al. in the April 2, 2009 edition of the New England Journal of Medicine added to the growing evidence that a significant impact on cancer mortality can be achieved by offering women even a single opportunity for cervical cancer screening using an HPV DNA test followed by treatment as indicated.

In contrast to previous findings, the new study from India found no significant reductions in cancer cases among women offered screening/treatment using cytology (Pap screening) or visual inspection with acetic acid (VIA). It is not unusual for studies to show differing results, and it is important to consider the entire body of evidence before significantly revising policy. This Alliance for Cervical Cancer Prevention (ACCP) fact sheet seeks to put the new findings into context and respond to questions arising in light of this new information, especially questions related to continuing investment in VIA-based programs.

ACCP history with HPV testing and VIA

Cervical cancer kills approximately 270,000 women each year, with nearly 85 percent of those deaths in resource-poor settings. Routine cytological screening of women has resulted in a dramatic decline in cervical cancer deaths over the past four decades in wealthier countries. A key reason for continuing high mortality in the developing world is the shortage of efficient, high-quality precancer screening and treatment programs in those regions.

Most developing countries lack the infrastructure and trained personnel needed to replicate the cytology-based, multi-visit approach used in wealthier countries to detect precancer (Pap smears followed by colposcopy and biopsy).

In an effort to investigate sustainable alternatives to cytological screening, the ACCP —EngenderHealth, International Agency for Research on Cancer (IARC), Jhpiego, Pan American Health Organization (PAHO), and PATH — implemented a coordinated research agenda aimed at assessing a variety of approaches to cervical cancer screening and treatment (especially approaches that may be better suited to low-resource settings).

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