"Screen and treat" cervical cancer programs effective in poorly resourced areas

According to a new study two "screen and treat" Cervical cancer prevention programs developed for high-risk women in low-resource settings resulted in a lower prevalence of precancerous cervical lesions and Cervical cancer, according to a study in the November 2 issue of JAMA: The Journal of the American Medical Association.

Every year 471,000 cases of Cervical cancer are diagnosed and 233,000 women die from it worldwide.

The bulk of these cases occur in poorer countries with inadequate cancer treatment resources, where women are at a higher risk of developing Cervical cancer.

Presently in most developed countries, Cytology (cell) -based screening programs have considerably reduced the risk.

Such screening programs have been difficult to implement in poorer areas, but recently, a new approach has been proposed that avoids the complex health infrastructure required by traditional approaches.

Lynette Denny, M.D., Ph.D., of the University of Cape Town, South Africa, and colleagues conducted a study to determine the safety and efficacy of two screen-and-treat approaches for Cervical cancer prevention.

This approach combines testing for human papillomavirus (HPV) by DNA testing, visual inspection with a weak acetic acid solution, VIA, and then treating the lesions by using cryotherapy, a treatment that involves applying nitrous oxide to lesions of all eligible women with positive test results.

Cryotherapy is a relatively low-technology treatment method and the approach has the advantage for low-resource settings because it does not require specialized equipment for examination of the vagina and the cervix, overcoming two of the greatest barriers to Cervical cancer prevention.

To date however, the efficacy of these screen-and-treat approaches has not been established, and there has been only limited safety data.

In the clinical trial 6,555 nonpregnant women, aged 35 to 65 years were included, and the it was conducted between June 2000 and December 2002 at mobile women's health clinics in Khayelitsha, South Africa.

All patients were screened using human papillomavirus (HPV) DNA testing and visual inspection with VIA.

Women were subsequently randomized to 1 of 3 groups: cryotherapy if she had a positive HPV DNA test result; cryotherapy if she had a positive VIA test result; or evaluation was delayed.

The researchers found that compared with the delayed evaluation group, the screen-and-treat approach using HPV DNA testing was associated with a 77 percent lower prevalence of cancer than in the delayed evaluation group at 6 months, whereas the screen-and-treat approach using VIA was associated with a 37 percent lower prevalence.