We now have an extraordinary opportunity to address cervical cancer in developing countries, where 80% of the mortality occurs, thanks to intensive research over the past two decades into viable prevention strategies that can work even in the lowest-resource communities[i]. These include visual inspection with acetic acid (VIA), HPV testing (both linked to treatment) and vaccines.
We, the undersigned, affirm that we must address cervical cancer now. At the same time, we want to express concern over any rush to complex technologies, even “low-cost”, as the primary solution. As organizations working in some of the poorest countries, we must “walk in the shoes” of the women we serve in order to evaluate the feasibility of any approach. The following criteria are critical for success.
- Local access—Screening in her own community.
- Single Visit—Immediate results linked to timely treatment.
- Affordable— VIA costs US$0.23 per patient, HPV tests an expected $5-10, $10-25 for vaccines.[ii]
- Reproducible— Simple protocols easily taught by local trainer/providers.
- Sustainable— Proprietary supplies and equipment present insurmountable barriers for weak supply chain systems.
We believe the best option for successfully reducing mortality now lies in the model which links VIA and cryotherapy[iii], which has been successfully implemented in remote regions of the world. VIA studies have reported sensitivity comparable to cytology while requiring fewer specialized personnel and less infrastructure, training, and equipment.[iv] A single screening with VIA in a woman’s lifetime, between the ages of 30 and 50, with immediate treatment for all women who screen positive, can reduce the risk of cervical cancer by approximately 30% [Goldie et al].
We are at a crossroads in the fight against cervical cancer. As stated at the Women Deliver Conference in June 2010, we have an “unprecedented opportunity to give women and girls an equal chance at healthy and productive lives, free from cervical cancer.” The one immediately viable option at this time is VIA and the Single Visit Approach. Let’s unite in the goal of delivering what has been found to be effective now. When the HPV test or other new methods can be offered at an affordable price and sustainable in remote, low-resource settings, then we should embrace them as important options in the battle against this preventable disease. Now let’s do what’s proven and doable; let’s aim for reducing mortality by 30%. That’s an enviable goal for any cancer prevention strategy.
August Burns, PA, MPH,
Executive Director, Grounds for Health
Harshad Sanghvi, MD
Medical Director, JHPIEGO
Ricky Lu, MD, MPH
Director of Reproductive Health and Family Planning, JHPIEGO
Lynne Gaffikin, DrPH
President, Evaluation and Research Technologies for Health (EARTH) Inc
Consulting Associate Professor, Stanford University School of Medicine
Paul D Blumenthal, MD, MPH
Professor, Stanford University School of Medicine
Director, Stanford Program for International Reproductive Education and Service (SPIRES)