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Visual inspection: A low-tech tool for reducing cervical cancer rates

Visual inspection of the cervix, or neck of the womb, coupled with immediate treatment of any abnormalities may be the most cost-effective, comprehensive way to reduce cervical cancer in Thailand and other poor nations, according to researchers at Johns Hopkins and Georgetown universities. The scientists, who worked with reproductive health experts in Thailand, published their results in today's issue of the Journal of the National Cancer Institute.

Using data from Thai statistics on prevalence and costs of cervical cancer, as well as careful estimates of the quality of assorted screening tests, researchers developed a computer model to mimic the natural history of cervical conditions that lead to cancer.

They used the model to compare the costs and benefits of three screening techniques for cervical cancer: visual inspection; DNA testing for human papilloma virus (HPV), a known precursor of cervical cancer; or traditional Pap smears. In visual inspection, a health professional wipes a patient's cervix with acetic acid (vinegar), then looks for tissue abnormalities. Tissue harboring precancerous lesions turns white when exposed to vinegar.

Comparing each strategy with the next least expensive alternative, researchers found that visual inspection every five years in women ages 35 to 55, with immediate treatment where indicated being accepted by most women with eligible lesions, was the most cost-effective option at $517 per year of life saved. Only if HPV testing could be provided for $5 and 90 percent of patients agreed to follow-up care could HPV screening provide similar results, at a cost of $679 per life year saved. Pap smears would be as efficient only if at least 90 percent of the women received follow-up care and the tests were at least 80 percent sensitive in accurately detecting precancerous lesions.

Compared to no screening, the scientists estimate that visual inspection could achieve an 83 percent reduction in cervical
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Contact: Karen Blum
kblum@jhmi.edu
410-955-1534
Johns Hopkins Medical Institutions
2-Oct-2002


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