Results of the study, published in the March 8 issue of The Lancet, found that same-day testing and treatment led to high rates of compliance with recommended treatment compared with the more conventional practice of diagnostic testing and treatment in separate visits. Of 756 women treated the same day as diagnosis of precancerous lesions, 83.2 percent returned for a follow-up visit, and 93.5 percent returned for a checkup one year later.
"The vast majority of women said they were highly satisfied with this 'one-stop' approach, making it more likely they will continue with regular checkups and stay healthy," says Paul D. Blumenthal, M.D., M.P.H., an author of the paper and an associate professor of gynecology and obstetrics at Johns Hopkins.
Local nurses used vinegar to wipe the cervix and then visually inspect it for lesions that turn white when exposed to the solution. They then offered immediate treatment to women with positive tests (possible precancerous lesions).
Treatment consisted of cryotherapy, using compressed carbon dioxide to freeze and destroy abnormal tissue. Women with more advanced lesions, suspected cancers or other problems were referred to specialists. A year later, 94 percent of the women treated had no signs of any precancerous lesions. In addition, nearly 98 percent had recommended testing to others and nearly 95 percent said the treatment was equal to or better than expected.
Simple, low-technology testing and treatment methods such as these are urgently needed, says study author and epidemiologist Lynne Gaffikin, Dr.P.H., of Johns Hopkins. Only 5 percent of women in developing countries are likely to have been screened at any point in the previous five years, compared with industrialized countries where up to 70 percent of the population may have been tested using Pap tests as a standard screening tool.
Cervical cancer is primarily a sexually transmitted disease caused by the human papilloma virus and is the leading cause of female cancer deaths in parts of Africa, Asia and Latin America, killing more than 200,000 women each year.
Thailand for more than 30 years has struggled to create a successful cervical cancer prevention program based on a "test and refer" approach – taking a Pap smear and referring patients to specialists as needed, Blumenthal says.
"Our results clearly illustrate that a single-visit approach is safe, acceptable and feasible, and with sustained effort, can reach a moderate portion of the population," he says. "It appeared to be well-liked not only by the women we tested, but also their partners and the project providers."
Between February and October 2000, 5,999 women were tested at village health centers and hospitals in four districts of mostly rural Roi-et Province, Thailand. They were on average 36.7 years old and had 5.6 years of education. Most (97 percent) were married or living with a partner. More than half (58 percent) received services at a primary care center; the others were examined in a hospital. Nurses identified suspect precancerous cervical lesions in 13 percent of the women and possible cancer in four women.
More than 90 percent of those with abnormal lesions received cryotherapy. Those with suspect cancers were followed up at a referral hospital, where one case was confirmed. Only 2 percent of the women required clinical management for a perceived problem other than reassurance regarding side effects.
Part of the success behind the program lay in the cooperation of the Thai Ministry of Public Health, says Khunying Kobchitt Limpaphayom, study author and professor of gynecology at Chulalongkorn University in Thailand. Eligible women visiting the health centers for any reason were invited to be tested. Ministry volunteers who routinely conduct health promotion activities in villages provided information about the project through brochures, talks and loudspeaker announcements.
A similar study is under way in Ghana, West Africa.
The study was funded by a grant to JHPIEGO Corp. (an affiliate of The Johns Hopkins University committed to international reproductive health interventions in areas with limited resources) from the Bill and Melinda Gates Foundation through the Alliance for Cervical Cancer Prevention, and by the Ministry of Public Health of Thailand.
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Journal
The Lancet