New Method for Cervical Cancer Prevention

The Pan American Health Organization (PAHO) is promoting a new "Screen and Treat" approach to cervical cancer prevention that has proven in studies to be simpler and more cost-effective than the traditional Pap smear when used in Latin America and the Caribbean.

The new approach uses Visual Inspection with Acetic Acid (VIA) to detect abnormal cervical cells and then provides immediate treatment with cryotherapy of patients who have precancerous cells.

Studies of the method were carried out by the Alliance for Cervical Cancer Prevention, of which PAHO is a member, with support from the Bill & Melinda Gates Foundation through a grant to the Pan American Health and Education Foundation. The studies showed that use of the method significantly improved follow-up rates. In Peru, for example, only 10 percent of women screened with the new method failed to get follow-up, compared with 75 percent of women screened in a previous program based on the Pap smear.

"This method is accurate, acceptable to women, faster in providing results and treatment, and less costly," said Silvana Luciani, a PAHO expert on cervical cancer, at a U.S. congressional briefing on the method in June.

Cervical cancer is a public health problem throughout the Americas, but rates in Latin America and the Caribbean are four and a half times higher in than in the United States and Canada. Some 33,000 women in Latin America and the Caribbean die of the disease each year, compared with some 5,000 in the United States. Rates are also higher among Hispanic women than among non-Hispanic white women in the United States.

The new Screen and Treat approach is intended to address a number of obstacles that have plagued Pap-based prevention programs in Latin America and the Caribbean. Many women in the region lack access to screening, particularly those in rural areas with no health clinic nearby. Even women with good access often fail to get screened due to lack of awareness, fear, or embarrassment about the procedure. Women who do get screened in many cases fail to return to the health facility to get the results of their tests. And finally, those with positive results often fail to seek treatment to remove their cancerous cells.

With Screen and Treat, only one visit is needed to both detect precancerous cells and remove them.

PAHO Director Mirta Roses said the new approach, if properly implemented, could save thousands of lives. "The message is that early screening, early detection are key," she said. "We need to bring women into health facilities by having gender-friendly services, by helping them to overcome obstacles in their families and communities, and by not having too many steps in the treatment process. As it is, we too often get women when it is too late, too costly, too painful."

PAHO plans to promote the Screen and Treat approach by focusing on five countries-Bolivia, Haiti, Honduras, Guyana, and Nicaragua-where the burden of cervical cancer is particularly high. So far, Bolivia, Colombia, Guatemala, and Peru are employing the method on a small scale.

Members of the Alliance for Cervical Cancer are PAHO, PATH, the International Agency for Research on Cancer, JHPIEGO, and EngenderHealth.

For more information, read Lessons Learned from the TATI Demonstration Project.