Today's New York Times has an article summarizing the disturbing results of a new study looking at trends in cervical cancer morbidity and mortality in Latin America.
In an era in which most cases of cervical cancer can be prevented or detected early and treated, the study – sponsored by the Sabin Vaccine Institute, the Pan American Health Organization, and the US CDC, among others – concluded that cervical cancer-related deaths are likely to double in Latin America in the next 20 years. 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. Most of these women also lack access to newly-approved HPV vaccines.
Does this truly have to be the case? Must we continue to needlessly condemn 250,000 poor women to death every year? Even if we accept the argument that current screening and treatment technologies – Pap smears and the HPV vaccine – are too costly to be used widely in resource-poor countries like Haiti and Nicaragua, what about lower cost screening technologies like VIA (visual inspection of the cervix using acetic acid)?
For almost a decade, it has been known that clinicians, usually nurse-midwives, can detect more than three-fourths of pre-cancerous and cancerous cervical lesions simply by wiping a patient's cervix with acetic acid (white vinegar) and examining it visually. That this method is not more widely used, particularly in light of a recent Lancet study showing that VIA is as effective as traditional screening methods in India, is shameful.
It's time to wake up and smell the vinegar ...
Showing posts with label resource-poor nations. Show all posts
Showing posts with label resource-poor nations. Show all posts
Tuesday, May 20, 2008
Monday, August 13, 2007
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.
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.
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