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1-visit screening, prevention for cervical cancer holds promise

April 02, 2007

STANFORD, Calif. — A method of screening women in Ghana for early signs of cervical cancer and providing preventive treatment at the same visit appears to be safe, acceptable to women and feasible, according to a study by a researcher at the Stanford University School of Medicine.

If this technique can be scaled up effectively, it could help prevent one of the leading causes of cancer death in women in developing countries, said Paul Blumenthal, MD, MPH, acting professor of obstetrics and gynecology. He is the lead author of the study, which will be published in the April issue of the American Journal of Obstetrics and Gynecology.

In developed countries such as the United States, women receive a regular Pap smear to detect early signs of cervical cancer. Those with abnormalities on the Pap smear are called back for follow-up treatment. Although this approach is effective at detecting and eradicating precancerous abnormalities, it requires a degree of infrastructure that isn't often available in developing countries.

"Pap smears require equipment such as slides, reagents and even a working microscope, which might not be available in developing countries," said Blumenthal. He carried out this work while on the faculty at Johns Hopkins University, in collaboration with the university's international health affiliate JHPIEGO and the Ghana Cervicare Group.

Almost 80 percent of the 490,000 cases of cervical cancer reported worldwide each year are in developing countries, such as Ghana. Each year, more than 250,000 women die from the disease. According to Blumenthal, for women in developing countries who survive childbearing, cervical cancer is often the next potentially fatal reproductive health issue they face.

The technique used in this study is one that has been known for many years. A doctor or nurse applies acetic acid, essentially vinegar, to a woman's cervix. Precancerous areas stand out as white regions against the pink, normal cervical tissue. The doctor or nurse can then freeze away the white regions using a technique called cryotherapy, which involves a commonly available gas, effectively eliminating the abnormality and preventing future cancer. This single-visit procedure eliminates the need to call women back to the clinic for repeat testing and requires less infrastructure than other methods of detecting cervical cancer.

In this study, the researchers recruited women in the Ghanaian city of Accra. They found that of the 3,665 women screened, 90 percent said they were satisfied with the procedure. Of the 427 women who had abnormalities removed, most experienced some pain, but only 5.6 percent of women came back to be seen for a problem after the therapy. One year later, only 2.6 percent of the women they treated had additional abnormalities turn up.

Blumenthal said these results are a good indication that a one-visit approach to cervical cancer screening could be effective in Ghana's urban areas. However, this study didn't address whether the technique can be effective in a rural setting or whether the government would be able to scale up the procedure to treat women nationwide. A follow-up study is under way in rural Ghana. Blumenthal also said that related projects by the World Health Organization are being conducted in several other African nations.

If the technique proves widely effective, the governments will need both financial and logistical help scaling up the procedure to make it generally available. "The real needs are the start-up costs, getting the projects off the ground," he said.

Stanford University Medical Center