New Approach to Cervical Cancer in Developing Countries Appears Safe and Effective
Each year, ]]>cervical cancer]]> kills more than 230,000 women worldwide. About 80% of cervical cancers occur in developing countries, which do not have the resources to implement Pap smear screening programs that have steadily reduced the incidence of cervical cancer in the United States. A new “screen-and-treat” program takes a more efficient and less costly approach to both screening and treating cervical cancer, making it more practical for developing countries.
In an article published in the November 2, 2005 Journal of the American Medical Association , researchers attempted to determine whether the screen-and-treat approach was effective and safe. They found that women who’d undergone either of two screen-and-treat approaches were significantly less likely to have high-grade (most worrisome) precancerous lesions after six and twelve months than women in the control group. Major complications were rare.
About the Study
The researchers recruited 6,555 women, aged 35 to 65 years, who lived in South Africa. All of the women were screened for cervical cancer by two methods: 1) detection of human papillomavirus (HPV) DNA (HPV is a virus associated with aggressive forms of cervical cancer), and 2) visual inspection. The women were then randomly assigned to one of three groups. Women in the first group were treated with cryotherapy if they tested positive for HPV DNA. (Cryotherapy is a procedure that removes abnormal cells by freezing them.) Women in the second group were treated with cryotherapy if they had a positive result based on the visual exam. Women in the third, or control, group were reevaluated after six months regardless of their HPV DNA or visual examination test results.
At six months, the screen-and-treat approach using HPV DNA resulted in a 77% lower incidence of high-grade precancerous lesions compared to the control group, and the visual inspection approach resulted in a 37% lower incidence compared to the control group. The differences were still significant at twelve months. Many women complained of pain, discharge, and bleeding after cryotherapy, but major complications were rare.
How Does This Affect You?
This study found that both the HPV DNA and visual inspection screen-and-treat methods for cervical cancer were safe and effective, compared to delayed evaluation.
With early detection, death from cervical cancer is nearly 100% preventable. Over the past few decades, cervical cancer deaths have declined steadily in the United States, thanks in large part to the extensive use of Pap smears. Unfortunately, many developing countries, and even some impoverished areas in the U.S., lack the resources to implement these screening programs.
Screen-and-treat programs offer an alternate approach that makes the most of limited resources. Properly implemented, they have the potential to reduce cervical cancer deaths in women throughout the world.
American Cancer Society
National Cancer Institute
National Institutes of Health
Denny L et al. Screen-and-treat approaches for cervical cancer prevention in low-resource settings: a randomized controlled trial. JAMA . 2005; 294:2173-2181.
Last reviewed Nov 3, 2005 by ]]>Richard Glickman-Simon, MD]]>
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