About 80% of all cervical cancers occur in developing countries, including Latin America, sub-Saharan Africa, and Southeast Asia. In these countries, cervical cancer screening programs must compete with other health problems for funding. While the Pap smear has been the traditional screening approach for cervical cancer, studies have suggested that, in developing countries, visual inspection of the cervix with acetic acid (VIA) and human papillomavirus (HPV) DNA testing may be less expensive alternatives for cervical cancer screening.

VIA involves swabbing the cervix with diluted vinegar and looking for abnormal tissue. HPV DNA testing involves testing for DNA from the HPV virus, which has been strongly linked to cervical cancer.

In this study, Jeanne S. Mandelblatt, M.D., of the Georgetown University School of Medicine, Lombardi Cancer Center, and her colleagues used a computer model to simulate the societal costs and benefits of cervical cancer screening, diagnosis, and treatment in Thailand, a country with high rates of cervical cancer and no organized infrastructure for Pap testing. The researchers then compared the costs and benefits of 42 combinations of seven different screening strategies using one or more of the three screening tests performed at various intervals.

The screening strategies included Pap smear screening, HPV DNA testing, Pap smear and HPV DNA testing, VIA and immediate treatment of abnormal tissue, VIA with referral of women with abnormal results to a regional hospital, and VIA followed by HPV DNA testing.

Compared with no screening, all strategies reduced the incidence and mortality of cervical cancer at a cost of betw
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Contact: Linda Wang
jncimedia@oupjournals.org
301-841-1287
Journal of the National Cancer Institute
1-Oct-2002