Hope for innovative cervical-screening programmes in less-developed countries

A potential model for preventing deaths from cervical cancer in less-developed countries is outlined in this week's issue of THE LANCET. Authors of the study illustrate how a 'single visit' screening programme tested in rural Thailand could be effective in other less-developed settings.

Just under half a million cases of cervical cancer occur worldwide every year-and most women die because these cases occur in less-developed countries where there are no screening programmes to detect early-stage disease. As a result, innovative approaches to cervical-cancer prevention are being investigated, in this instance, using rural Thailand as a model for other less-developed areas of the world.

A team from the USA and Thailand, in collaboration with the Thai Ministry of Public Health, initiated a demonstration project in rural Thailand, where screening coverage remains low. The investigators assessed the value of a single-visit approach combining visual inspection of the cervix with acetic acid wash (VIA;) a potentially abnormal cervix (a positive VIA test) is quickly identified by white areas which can be treated by cryotherapy (destruction of tissue by freezing) at the same examination.

Around 6000 women from four rural districts in Thailand were tested with VIA over seven months in village health centres or in district hospitals. 13% of women tested positive, of whom 98.5% accepted cryotherapy treatment. Only 2% of women overall required clinical intervention for a perceived post-treatment problem. Both VIA and cryotherapy were highly acceptable to the women-over 95% expressed satisfaction with their experience. Screening was effective: 94% of women tested negative for VIA at one year's follow-up.

Paul Blumenthal (one of the investigators) comments: "These results clearly show that a single-visit approach with VIA followed by immediate treatment with cryotherapy for those testing positive (or referral as indicated) is safe, acceptable, feasible, and with sustained effort, can achieve moderate population coverage. The project provides important safety information for policymakers in developing countries who are considering how best to initiate or strengthen fledgling cervical-cancer prevention programmes."

Contact: Andrea Miller, Public Interest Media Group, 611 Broadway, Suite 730, New York, NY 10012, USA;
T) 212-260-1520;
Cell) 917-975-9325;
F) 212-260-1897;
E) andrea@publicinterestmedia.com

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