Cervical cancer is primarily a sexually transmitted disease caused by the human papilloma virus and is the leading cause of female cancer deaths in parts of Africa, Asia and Latin America, killing more than 200,000 women each year.
Thailand for more than 30 years has struggled to create a successful cervical cancer prevention program based on a "test and refer" approach taking a Pap smear and referring patients to specialists as needed, Blumenthal says.
"Our results clearly illustrate that a single-visit approach is safe, acceptable and feasible, and with sustained effort, can reach a moderate portion of the population," he says. "It appeared to be well-liked not only by the women we tested, but also their partners and the project providers."
Between February and October 2000, 5,999 women were tested at village health centers and hospitals in four districts of mostly rural Roi-et Province, Thailand. They were on average 36.7 years old and had 5.6 years of education. Most (97 percent) were married or living with a partner. More than half (58 percent) received services at a primary care center; the others were examined in a hospital. Nurses identified suspect precancerous cervical lesions in 13 percent of the women and possible cancer in four women.
More than 90 percent of those with abnormal lesions received cryotherapy. Those with suspect cancers were followed up at a referral hospital, where one case was confirmed. Only 2 percent of the women required clinical management for a perceived problem other than reassurance regarding side effects.
Part of the success behind the program lay in the cooperation of the Thai Ministry of Public Health, says Khunying Kobchitt Limpaphayom, study author and professor of gynecology at Chulalongkorn University in Thailand.
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Contact: Karen Blum
kblum@jhmi.edu
410-955-1534
Johns Hopkins Medical Institutions
6-Mar-2003