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Preventing Cervical Cancer
Karen Landovitz
Each year, 200,000 women in developing countries die from cervical
cancer. Yet, if cervical cancer precursors are detected and treated,
the disease can be prevented.
In a project funded in part by the Bill and Melinda Gates Foundation
and the Hewlett Foundation, staff from AVSC, Columbia University,
and the University of Cape Town have been investigating methods
of detecting and preventing cervical cancer in low-resource settings.
Screening Is Critical
Over 99% of all cases of cervical cancer stem from human papillomavirus
(HPV), a sexually transmitted infection. HPV is transmitted more
readily than most other sexually transmitted infections and is hard
to prevent.
HPV is difficult to detect without screening. Usually, the only
symptoms produced in women are lesions, or abnormal cells, in the
cervix. Some HPV lesions are precancerous but may not develop into
cancer until years later. This is why cervical cancer develops most
often in women ages 35 to 65.
When a woman is screened, any abnormalities of the cervix are
identified, assessed to determine whether they are likely to be
precancerous, and, if so, treated. Therefore, regular screening
to identify and treat precursor lesions before cancer forms is a
woman's best defense against cervical cancer.
Existing Tests
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Making Our Work Possible
This year, the Bill and Melinda
Gates Foundation awarded $50 million to the Alliance for Cervical
Cancer Prevention, a consortium consisting of AVSC, the International
Association for Research on Cancer, the JHPIEGO Corporation,
the Pan American Health Organization, and the Program for
Appropriate Technology in Health.
The Alliance will focus on four
key areas: technology assessment in low-resource settings;
development of guidelines for treatment, follow-up, and triage;
community involvement in the design, implementation, and evaluation
of screening programs; and advocacy efforts to prevent death
and address community needs.
AVSC is deeply grateful to the Gates
Foundation for its investment in reproductive health and preventive
medicine. |
The Pap smear is the principal method
used worldwide to screen for precursor lesions. However, it is not
widely available in low-resource settings. Analyzing the test can
be costly and requires equipment, highly trained staff, and systems
that often do not exist there.
One alternative to the Pap smear is
direct visual inspection (DVI) of the cervix. This method may be
more appropriate for screening in low-resource settings, because
it does not require such equipment or systems. However, DVI often
gives false-positive results, identifying some lesions as precursors
when they are not. This causes many women to receive unnecessary
treatment, which is costly, may be emotionally distressing, and
may increase their risk for other diseases.
Seeking Useful Methods
Finding effective alternatives to
the Pap smear is key to reducing cervical cancer in developing countries.
Since 1995, AVSC and our collaborators
have been conducting a research study in South Africa--where almost
37,000 new cases of cervical cancer occur each year--comparing four
screening methods to evaluate their potential for use in low-resource
settings. All women in the study are screened using all four methods
(including DVI and the Pap smear) and receive appropriate treatment
or referral, if needed.
In addition, as part of the Alliance
for Cervical Cancer Prevention (see box), we are further studying
the safety and efficacy of two of the methods--DVI and HPV DNA--and
researching the delivery of cervical cancer screening services.
In high-resource settings, cervical
cancer rates have dropped sharply after widespread screening programs
were introduced. Our aim is to provide women in low-resource settings
with the same opportunities to avoid this preventable disease.
Karen Landovitz is an editor and
writer at AVSC. She thanks Karen Beattie, who manages AVSC's research
and evaluation efforts, for her guidance in preparing this article.
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