Cervical cancer screening programs for low-resource areas appear effective and safe

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.

Each year 471,000 cases and 233,000 deaths occur from cervical cancer worldwide, of which 80 percent occur in less-developed countries that have access to less than 5 percent of global cancer treatment resources, according to background information in the article. The lifetime risk of a woman developing cervical cancer in a low-resource setting is approximately 2 percent to 4 percent. Cytology (cell) -based screening programs have markedly reduced the incidence of cervical cancer in developed countries that have the infrastructure to support these programs. However, these screening programs have been difficult to implement in low-resource settings.

Recently, a novel approach to cervical cancer prevention has been proposed that avoids the complex health infrastructure required by traditional approaches. This approach incorporates noncytology-based screening methods such as human papillomavirus (HPV) DNA testing or visual inspection with acetic acid (VIA; a weak acidic solution) followed by treatment of lesions using cryotherapy (medical treatment that involves application of nitrous oxide to lesions and a device using very low temperatures) of all eligible women with positive test results. Cryotherapy is a relatively low-technology treatment method. These approaches have advantages for low-resource settings because they are not cytology-based screening programs and do not require colposcopy (specialized equipment for examination of the vagina and the cervix), which overcome two of the greatest barriers to cervical cancer prevention. However, the efficacy of these screen-and-treat approaches has not been established, and there has been only limited safety data.

Lynette Denny, M.D., Ph

Contact: Elizabeth Streich
JAMA and Archives Journals

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