Cervical cancer is the leading cause of cancer-related death among women in the developing world, even though the disease is often easily treated when diagnosed at an early stage. Of the nearly half a million cases of cervical cancer diagnosed each year, about 80% are in developing countries, and it is likely that many more cases go undiagnosed.

AVSC is one of five organizations participating in a study currently underway in Cape Town, South Africa, that seeks to address the problem of cervical cancer screening and treatment for clients in low-resource settings. Results of the study should lead to development of a series of cervical cancer screening protocols for use at sites with different levels of resources.

A Treatable Disease
Cervical cancer, which most commonly occurs in women in their forties and fifties, develops slowly over a number of years, beginning with mild changes in cells of the cervix. In most women, these mild cellular changes spontaneously regress to normal tissue. Of those that progress to more severe lesions, about 20% to 50% of cases develop into invasive cervical cancer.

Over the past few years, it has become clear that cervical cancer is linked to a sexually transmitted disease and that most, if not all, cases are caused by sexual transmission of human papilloma virus (HPV). Factors such as early onset of intercourse and multiple sex partners increase the risk of cervical cancer due to the increased risk of HPV infection.

When detected early, most mild to moderate cervical lesions are easily treated. Thus, in developed countries where screening is available through a number of health care services, including family planning programs, cervical cancer is a preventable disease. Cellular changes can be detected with a Papanicolaou (Pap) smear--the standard screening tool. In the U.S., screening programs have led to a decline in the incidence and mortality of the disease: from the 1950s to the 1980s, the incidence of cervical cancer dropped by more than 85%.

In developing countries, however, cervical cancer is often diagnosed at an advanced and untreatable stage. Obstacles that prevent developing countries from instituting effective screening and treatment include a lack of health care facilities, the low priority of women's health issues, a lack of laboratories and trained cytologists to perform Pap smears, and women's lack of awareness of the need for cervical cancer screening.

A Collaborative Study
The new study is a collaboration between AVSC International and the College of Physicians and Surgeons of Columbia University, the University of Cape Town, the National Cancer Association of South Africa, and the Program for Appropriate Technology in Health.

The primary purpose of the study is to determine the potential utility of several screening methods in a low-resource setting. Accuracy of the more low-tech methods will be assessed by comparing them to results from more advanced screening methods.

A total of 3,000 previously unscreened women aged 35 years and older are expected to be enrolled in the study by July 1997. The final report is anticipated in 1998.

AVSC's participation in the Cape Town study is funded by a private donor.

Anupma Jain, medical project assistant and program manager for the study, and Dr. Mark Barone, medical associate, work in AVSC International's Medical Division.