A Little Dab Will Do Ya ...

[cross-posted from GCM News ... sign up for the Global Campaign for Microbicides newsletter at http://global-campaign.org]

A simple technique using nothing more than cotton swabs and vinegar could help prevent the deaths of more than 250,000 women a year. Cervical cancer – a sexually transmitted disease caused by the human papilloma virus (HPV) – is the leading cause of cancer-related mortality in the developing world. Early diagnosis and treatment is key, but current screening and treatment technologies, such as Pap smears and the newly approved HPV vaccine, are too costly to be used widely in resource-poor countries. Fewer than five per cent of women in Africa, Asia and Latin America are screened for cervical cancer, as compared to 70% of women in North America and Europe.

In 1999, researchers in the U.S. and Zimbabwe showed that trained nurse-midwives who wiped a patient's cervix with acetic acid (white vinegar) accurately detected more than three-fourths of pre-cancerous and cancerous lesions; tissue harboring such lesions turned white when exposed to vinegar, and could be easily seen during a visual inspection of the cervix.

In a study recently published in the British medical journal The Lancet, researchers in India and France have built upon that finding to show that this method – visual inspection of the cervix using acetic acid (VIA) – is as effective as Pap smears for detection of cervical cancer and dysplasia. In the study, 49,311 sexually active women in Tamil Nadu were randomized to receive VIA or existing cervical screening and care. Women who were VIA-positive were offered further treatment, including cryotherapy to remove any lesions, or a referral if they had invasive cancer. Women who underwent VIA had a 25 percent reduction in cervical cancer incidence and a 35 percent reduction in deaths compared with the women who received standard screening and care.

As promising as these results are, however, it is important to note that the Lancet study was performed at a clinic with dedicated staff and in an area where treatment for cervical cancer was readily available. The VIA screening method is simple and cheap, but many women in resource-poor countries still lack access to basic medical services, let alone treatment and care for cervical dysplasia or cancer. As always, technologies are only useful if they are not only effective but also available, affordable and acceptable to the people who need them.

The painful irony is that cervical cancer screening is of no use to women who cannot access treatment to prevent the onset of cancer. This breakthrough only underscores the need to advocate relentlessly for adequate access to the full spectrum of reproductive health care options, including (and especially) treatment for life threatening conditions. This is surely a case in which half a loaf really isn’t better than no loaf at all.