Wider Use Of Simpler Cervical Cancer Screening Could Benefit Women In Developing Countries

This is among the key findings reported in an English-language article in the current (January 2005) issue of the "Revista Panamericana de Salud Pública/Pan American Journal of Public Health," a peer-reviewed public health journal published by the Pan American Health Organization (PAHO).

This finding is considered important because cancer of the cervix -- at the base of the uterus -- is the second only to breast cancer as the most common form of cancer among women. Cervical cancer is caused by a sexually transmitted virus, which causes lesions to grow on the cervix. If left untreated, those lesions ultimately develop into cancer.

Cervical cancer kills more women annually than childbirth, and it is estimated that it could affect as many as 750,000 women by 2020 and as many as 1 million new cases by 2050. Currently, about 230,000 women die annually of cervical cancer and nearly 80 percent of these cases occur in underdeveloped and poverty-stricken countries. The article's principal author, physician Jose Jeronimo is from Peru and works at the Division of Cancer Epidemiology and Genetics of the National Institutes of Health's National Cancer Institute. He said that the screening method using vinegar – known as VIA (the acronym for visual inspection with acetic acid) – should be seen as an alternative to the Papanicolaou smear, commonly known as the Pap smear.

With VIA, more women are likely to be followed up and receive any additional confirmatory testing needed, and treatment. Given those advantages, the VIA is being introduced in developing nations around the world. However, that screening is recommended primarily for low-resource settings, with medical personnel with limited training and with only modest medical equipment.

Many of those same advantages, however, could be found in settings in developing countries with better-trained staff and more extensive, up-to-date medical equipment, according to the "Revista/Journal" article. This study was the first research ever done to try to address that question in a developing country.

In wealthier developed countries, women routinely undergo examinations and Pap smears in which a smear of cervical cells is taken and evaluated at a laboratory to detect any abnormality. But the inexpensive vinegar test – explained in the article -- involves washing the cervix with vinegar for one minute. Then, the health worker performs a naked-eye observation of the cervix to see whether the epithelium, a protective tissue layer, turns white. This would indicate precancerous lesions.

Dr. Jeronimo said that "it has always been said that this VIA method was only applicable" in low-income developing nations with few resources. However, he noted that one of the key results of the Lima test is that "it showed that the vinegar screening is also valuable and has an important role to play in places in developing countries with good resources and a good infrastructure."

The other key finding, Dr. Jeronimo said, is that when the Pap smear is used to detect cervical cancer "many women never return to be diagnosed and be informed of their treatment, or they don't adhere to their treatment. With a Pap smear, you have to return to know the results."

It's much quicker and simpler with the vinegar or VIA test.

According to the article, VIA-positive women knew their abnormal result immediately during the first visit, and they immediately received special counseling about that finding and the importance of returning in a week for confirmatory studies with colposcopy and biopsy. In contrast, to learn about their Pap smear result -- either positive or negative -- women had to return one week later for a second visit, which many of them did not do and so never received special counseling about the significance of any positive result.

The article is based on a study of 1,921 women carried out at the Peruvian Cancer Institute (Instituto de Enfermedades Neoplásicas) in 1999 and 2000. Both VIA and Pap smear screenings were used. According to Dr. Jeronimo, the study showed that while "26 percent of women who were Pap-positive did not return for follow-up procedures, only 3 percent of the VIA-positive women did not return."

The article notes that the results of the Lima tests "outline the potential benefits of using VIA at all levels of health care systems in developing countries. VIA increases (early) detection of premalignant lesions of the cervix and diminishes the probability of losing women before they are appropriately followed up and treated."

"We believe," the article adds, "that VIA can be used as a screening tool in poor countries not only in rural areas and small health centers but also in hospitals, cancer institutes, and other health facilities with better resources."

The monthly "Revista/Journal" is the leading scientific journal of the Pan American Health Organization (PAHO), which serves as the Regional Office for the Americas of the World Health Organization (WHO).

Last month, PAHO -- as a member of the Alliance for Cervical Cancer Prevention (ACCP) -- issued a new publication and reported that cervical cancer, while largely preventable, kills almost a quarter-million women worldwide each year. The publication, a 255-page "Manual for Planning and Implementing Cervical Cancer Prevention Programs," is a result of the collective experiences of the Alliance, which includes PAHO and four other international health organizations: International Agency for Research on Cancer (IARC), PATH, EngenderHealth, and JHPIEGO.

The health alliance said in the report, which was issued in Geneva in December, that about 80 percent of the 500,000 new cases of cervical cancer each year worldwide occur in developing nations, mainly in Latin America, sub-Saharan Africa, and the Indian subcontinent.

A month earlier, a PAHO report -- titled "A Situational Analysis of Cervical Cancer in Latin America and the Caribbean" -- noted that incidence and mortality rates from cervical cancer have declined steeply in North America, to below 10 per 100,000 females in both Canada and the United States. Yet rates in most Latin American and Caribbean countries are higher than 20 cases per 100,000 (in many cases, much higher) and are surpassed only by rates found in East Africa and Melanesia. In addition, cervical cancer accounts for a higher percentage of cancer deaths in the Americas--as high as 49.2 percent in Haiti, compared with 2.5 percent in North America.

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The Pan American Health Organization (PAHO) was established in 1902 and is the world's oldest public health organization. PAHO works with all the countries of the Americas to improve the health and quality of life of its people.