Preventing Cervical Cancer in Low-Resource Settings

<em>Courtesy of Bill & Melinda Gates Foundation, Map of Global Burden of Cervical Cancer</em>” width=”500″ height=”386″ /><figcaption id=Courtesy of Bill & Melinda Gates Foundation, Map of Global Burden of Cervical Cancer

Every year more than a quarter of a million women die from cervical cancer. Eighty percent of these women lived, and died, in the developing world, and most of them lacked access to the basic healthcare that could have saved their lives.

Cervical cancer is caused by certain strains of human papillomavirus (HPV), the most common sexually transmitted infection: the Centers for Disease Control and Prevention estimate that at least half of all sexually active men and women will get HPV at some point in their lives. There are more than 40 strains of genital human papillomavirus, some of which are relatively harmless. Other strains cause genital warts and various forms of genital cancer, including cervical cancer.

Because HPV is so common, one of the best defenses against cervical cancer is to catch it when it is still treatable. Cervical cancer is among the most treatable of cancers if it is caught early. There are several methods for doing so.

First, there’s the good ol’ PAP smear. Yup, that’s the once-a-year, vaginal speculum inspection to collect the cervical mucus and test it for telltale signs of cancer. Although many women in the developed world are all too familiar with this process, women in developing countries often do not get regular PAP smears because the test requires specialized equipment and advanced technical skills for which local practitioners don’t have the training. Another high-tech cervical cancer screening tool is colposcopy, which allows for the close inspection of the cervix with specialized equipment. Again, this is tool is not widely available in developing countries.

An alternative, though often under-utilized, technique is visual inspection of the cervix with acetic acid. In low-resource settings, this low-tech method is comparable in accuracy to the PAP smear. Like the PAP, it requires the insertion of a speculum.  The healthcare provider then looks for obvious signs of cancer, and swabs the cervix with acetic acid, ie, vinegar. Pre-cancerous lesions or abnormal cells will appear as white patches. If necessary, a woman can then be treated with cryotherapy, which is the freezing off of the problematic tissue in the cervix. Unlike the PAP smear test, which requires a lab to process the sample and the woman to return for treatment, if necessary; visual inspection and cryotherapy can be administered all in one visit. A trained nurse can do the test in a primary healthcare facility.

A DNA test for HPV is also available, which detects the presence of 13 of the most dangerous strains of HPV. Like the PAP, this test requires appropriate laboratory equipment and skilled lab technicians. A new version of this test called careHPV is currently being adapted for low-resource settings. It is expected that careHPV will be available in China by 2011 and in India by 2012. Healthcare providers with basic training could use this low-resource adaption even in places that lack electricity or running water.  It produces results in less than three hours, allowing for same day treatment.

In addition to regular preventive checkups, the best protection against cervical cancer is protection from HPV infection. Two HPV vaccines are currently on the market and are recommended for girls and young women, ideally before they become sexually active. Consistently using condoms may also offer some protection against HPV infection, but it is not fully protective because HPV is spread via skin-to-skin contact and not just through bodily fluids.

Susanna Smith is the Program Officer for Communications at the International Women’s Health Coalition. Read her bio  here .



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