A paper to be published in The Obstetrician & Gynaecologist (TOG) offers a cost-effective solution in the provision of effective cervical screening services in under-resourced countries.
Around 285,000 women worldwide die from cervical cancer each year. 80% of deaths occur in under-resourced countries. Unlike developed nations, where cervical screening programmes are well established, access to these services is limited in many countries in Africa, Asia and the Americas.
The main barriers to reducing the high cervical cancer rate in under-resourced countries are poor health service infrastructures and the high costs of screening and vaccines. Researchers from University College London and University College Hospital suggest that visual inspection with acetic acid (VIA) is undertaken instead of the more expensive HPV DNA testing or liquid based cytology (LBC).
VIA is a simple test where a very small dose of acetate acid solution is applied to the cervix to detect precancerous lesions. A positive result can be treated immediately with cryotherapy or a loop electrosurgical excision procedure. This is referred to as the ‘see and treat’ approach and may be appropriate for small clinics without advanced equipment and laboratories.
VIA is regarded as the best alternative to cytology and previous studies in rural settings have shown that it is accurate, leads to a reduction in the cancer mortality rate and is acceptable to women. Cost-wise, VIA screening costs approximately US$2 per woman, compared to >US$9 per woman for cytology. The authors point out that the drawback to using VIA is over-diagnoses which may lead to unnecessary treatment and health services need to ensure that appropriate training and monitoring are in place.
Authors point out that even if the VIA test is in place, the ultimate hurdle that healthcare professionals need to overcome in the push to improve cervical cancer rates in under-resourced countries is the lack of awareness among women about the need for screening. Education programmes that engage local communities are needed to empower women.
Researcher David McGregor, from UCL, said “Visual Inspection with Acetic Acid (VIA) is an effective and affordable tool to screen women for pre-cancerous lesions of the cervix in under-resourced countries. Coupled with simple treatment measures, VIA could potentially reduce these cancer deaths by a third, which means nearly 100,000 women saved each year.
“The main barriers are financial and the low awareness of the benefits of screening among women. Successful implementation of VIA depends on the political will of governments to finance national screening programmes for women as a well as a comprehensive educational campaign on the benefits of screening and early treatment.”
Mr Jason Waugh, TOG editor-in-chief, said “The VIA test has been shown to be effective in resource-poor settings, but even with all the best will in the world, cervical cancer screening programmes will not work if women are not engaged.
“Rising awareness about screening programmes to ensure higher uptake in the population is always a challenge; especially among rural and isolated communities. There are also other considerations such as cultural and social factors which may impede uptake. Health services and voluntary organisations must work closely with local groups to spread these messages.”
The Obstetrician & Gynaecologist (TOG) is published quarterly and is the Royal College of Obstetricans and Gynaecologists' (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer-reviewed journal aimed at providing health professions with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology.
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McGregor D, Olaitan A. Fighting cervical cancer in under-resourced countries. The Obstetrician & Gynaecologist 2010;12:49–52.