Low Tech Cervical Cancer Test Is Effective Says New Study

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Main Category: Cervical Cancer / HPV Vaccine
Also Included In: Cancer / Oncology;  Medical Devices / Diagnostics;  Women's Health / Gynecology
Article Date: 03 Aug 2007 - 9:00 PDT

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A new study by scientists from India and the International Agency for Research on Cancer (IARC) suggests that a cheap and simple "low tech" visual screening test for cervical cancer could save many thousands of lives worldwide every year.

The study is published in the Lancet.

Cervical cancer is the most common cancer in women in developing countries where 85 per cent of the world's nearly half a million cases and over quarter of a million deaths from cervical cancer are found. It is a "major problem for global public health", said Dr Peter Boyle, Director of IARC.

While the preferred method for reducing cervical cancer worldwide is to encourage as many countries as possible to vaccinate their young women and girls against HPV before they are sexually active, there remains the problem of what to do in the meantime for the many thousands of women for whom early screening could be a life saver.

For decades the Pap Smear test (named after Georgios Papanicolaou, the Greek cytologist who developed it) has been regarded as a safe, reliable and effective screening device for detecting cancerous and pre-cancerous cells in the cervix. However, because of the lab resources and logistics needed to ensure the test works, it is not possible to introduce it to all the parts of the world, and particularly in places where cervical cancer is most prevalent.

The researchers behind the study, Dr Rengaswamy Sankaranarayanan and colleagues trialled a simple and cheap screening method where the doctor paints the cervix using a cotton gauze soaked in 4 per cent acetic acid (the main ingredient in vinegar), waits for a minute or so, and then inspects the area by eye with the help of a bright halogen lamp. Precancerous lesions turn white when painted with acetic acid.

The test is called VIA, short for visual inspection with 4 per cent acetic acid.

The trial is the largest randomized controlled trial in a low-resource setting of a screening test for cervical lesions that is based on visual inspection. The setting in this case was rural India, and screened over 30,000 women between 2000 and 2007, with around the same number of controls who were not screened using the VIA test.

The cases included in the trial were registered with the Dindigul Ambilikkai Cancer Registry (DACR).

Over 31,000 women were screened using the VIA test and of these just under 1,900 were diagnosed with precancerous lesions, and 72 per cent were treated.

The results showed that VIA is effective at reducing cases and deaths from cervical cancer, as long as the women who are found to have lesions can receive effective treatment.

The women receiving VIA screening were 25 per cent less likely to receive a diagnosis of cervical cancer and 35 per less likely to die from the disease compared to the women who did not have the test.

The study concluded that:

"VIA screening, in the presence of good training and sustained quality assurance, is an effective method for preventing cervical cancer in developing countries."

Dr Jacob Cherian, Director, Christian Fellowship Community Health Centre, Ambillikai, in India said that:

"VIA offers a real-time advantage over other screening methods, particularly in low-resource settings, with the distinct improvement of diagnosis and rapid treatment at one go, meaning minimal dropouts. In addition, a range of healthcare personnel can perform it, from the nurse level up."

Dr Esmy, Principal Investigator at the same Community Health Centre said that it was important to set up screening alongside immunization in order significantly to reduce the incidence and deaths from cervical cancer in low-resource nations.

The role of good training and quality control was essential to effective VIA, according to the researchers:

"The key to success is providing highly effective training of personnel and ensuring that quality control standards at all parts of the procedure are in place," said Sankaranarayanan.

"Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial."
Rengaswamy Sankaranarayanan, Pulikkottil Okkuru Esmy, Rajamanickam Rajkumar, Richard Muwonge, Rajaraman Swaminathan, Sivanandam Shanthakumari, Jean Marie Fayette, Jacob Cherian.
The Lancet 2007; 370:398-406.
DOI:10.1016/S0140-6736(07)61195-7.
Published 4th August 2007.

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Written by: Catharine Paddock
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