PATH (Seattle)

Africa: New Findings Support Alternatives to Pap Test

press release

The Alliance for Cervical Cancer Prevention (ACCP), a partnership of five international public health research organizations, today announced key findings and recommendations resulting from eight years of studies in more than 20 countries in Africa, Asia, and Latin America. At the top of the list: early identification of precancer using simple, visual inspections of women is as effective, and in some cases more effective, than technically difficult and expensive Pap testing.

Cervical cancer, caused by the human papillomavirus (HPV), affects about 500,000 women each year and kills 270,000 annually. There is a huge discrepancy between cervical cancer deaths in rich and poor nations—80 to 85 percent of deaths occur in the developing world. In developed countries, screening programs using the Pap smear are in place to spot disease and treat it early, saving countless lives. However, a successful Pap testing program requires a high degree of organization, sophisticated laboratory equipment, and highly trained technicians. Unfortunately, in spite of efforts by many governments, large-scale Pap screening programs have not worked in poorer regions. It was frustration with this lack of success that mobilized ACCP efforts to find alternative approaches to Pap testing. Funding was provided by the Bill & Melinda Gates Foundation.

During a panel presentation at the Goethe-Institut in Washington, DC, Dr. Jacqueline Sherris of PATH, an ACCP founder, noted that "cervical cancer represents a huge global inequity with a heavy burden on poor women. It is an awful disease that shatters families by taking women at the peak of their productive lives, when they are in their 40s and 50s. Often, and especially in communities with large numbers of AIDS orphans, these grandmothers and aunts play a crucial role in raising children and maintaining social cohesion."

Dr. R. Sankaranarayanan, of the International Agency for Research on Cancer, has studied alternatives to Pap smear screening in India and other countries. He explained that cervical cancer is easy to treat if precancerous signs are detected early. Treatment in low-resource settings often can be done using a device that destroys the affected tissue by freezing, the same way that common warts are frozen.

For the visual screening methods tested by the ACCP, a trained health worker swabs the patient's cervix with vinegar (a painless procedure). After one minute, any small lesions on the cervix—signs of potential future cancer—can be seen with the naked eye. "In most cases it is possible to treat the women for precancer during the same visit to the clinic," says Dr. Harshad Sanghvi of JHPIEGO, another ACCP partner. "This is important because if a woman is sent home the day of the exam, and asked to come back days or weeks later to hear the results and be treated, she may not be able to return. In the past many women have missed the care they needed for this reason. Treatment in the late stages of cervical cancer—when women suffer symptoms—is difficult and often not successful. We need to screen all women, beginning at age 30, and provide rapid treatment to those who need it."

"New technologies for cervical cancer prevention are revolutionizing public health," according to Silvana Luciani of the Pan American Health Organization. "Visual screening methods, high-tech DNA tests for HPV, and the new HPV vaccines represent incredible opportunities to strengthen prevention. We need to protect girls from HPV infection with vaccine, but immunization is not a substitute for screening. Screening programs are needed to care for women who may have already been infected with HPV, because the vaccine does not protect them effectively and there are cancer-causing types of HPV not targeted by the vaccine. Research indicates that a combination of vaccination and screening can dramatically reduce cervical cancer deaths in the coming decades."

In her closing remarks, Dr. Sherris challenged US and European donors and policymakers to take a leadership role in improving cervical cancer screening, and HPV vaccination, worldwide. "Every woman has the right to screening at least once in her lifetime, and girls have the right to HPV vaccination. This is our goal, and it is achievable."

The ACCP partners are EngenderHealth, JHPIEGO, the International Agency for Research on Cancer, the Pan American Health Organization, and PATH.

Web resources

ACCP website

RHO Cervical Cancer

Alliance for Cervical Cancer Prevention

In 1999, five international health organizations (EngenderHealth, JHPIEGO, the International Agency for Research on Cancer, the Pan American Health Organization, and PATH) came together to create the Alliance for Cervical Cancer Prevention (ACCP). They were determined to find effective methods that health care workers in the developing world could use to identify cervical cancer early on, when it can be successfully treated in relatively simple and inexpensive ways. Over the past eight years, and with generous support from the Bill & Melinda Gates Foundation, the ACCP partners have been assessing a variety of approaches to cervical cancer screening and treatment, improving service delivery systems, ensuring that community perspectives and needs are incorporated into program design, and raising awareness about cervical cancer and effective prevention strategies.

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