Preventing Cervical Cancer in Developing Nations
For immediate release: July 26, 2001
Boston, MA-- An analysis of cervical cancer in the developing world, where the disease is the leading cause of cancer death in women, finds that between one quarter and one third of these lives could be saved by new approaches to cervical cancer prevention that incorporate novel screening methods. The analysis team was led by Dr. Sue Goldie of the Harvard Center for Risk Analysis, part of the Harvard School of Public Health, and Dr. Thomas Wright of Columbia University College of Physicians and Surgeons.
The analysis appears in the June 27, 2001 issue of the Journal of the American Medical Association. It could prove a turning point in dealing with cervical cancer in the developing world because it is the first to incorporate new approaches to cervical cancer prevention into a comprehensive policy overview. Because these strategies appear to offer enormous public health impact for low resource settings, it highlights the urgent need for clinical studies to evaluate the safety and long-term effectiveness of the new cervical cancer screening approaches.
Cervical cancer is the third most common cancer world wide, killing approximately 190,000 women each year, most of whom live in the developing world. In richer nations women have access to Papanicolaou (Pap) tests that allow pre-cancerous lesions to be detected and treated before they develop into full-blown cancer. The problems with doing such screening in poorer countries have been cost, the availability of technology and trained clinicians, and the infrastructure to track women with abnormal results.
The policy model developed by Dr. Goldie evaluated other approaches to cervical cancer prevention that incorporate either testing for human papillomavirus (HPV), which is the virus that causes cervical cancer, or a simple visual screening method called Direct Visual Inspection of the cervix (DVI) and immediately treating all women with abnormal screening tests. DVI involves nothing more than application of a mildly acidic solution to the cervix that turns pre-cancerous tissue white. It's so inexpensive that the costs of screening and treating women in low-resource settings with this approach are more than recouped by the savings realized by preventing the women from developing full-blown cancer. The policy analysis also suggests that screening with either HPV DNA testing or DVI, coupled with immediate treatment of all women with abnormal screening tests, might be considerably more effective than using Papanicolaou tests to screen.
Another critical finding in the analysis is that cervical cancer screening remains an effective public health investment even in nations ravaged by AIDS. The screening is most effective for women in the mid and late 30's, most of whom have survived the peak fatality years for AIDS (the late teens and 20's) and who have an otherwise normal life expectancy. These women play an ever-more vital role as surrogate mothers and teachers in rural societies where so many younger women have died of AIDS.
The other researchers who contributed to the study were Dr. Lynette Denny of the University of Cape Town, South Africa, Dr. Louise Kuhn, of the School of Public Health of Columbia University, and Dr. Amy Pollack of EngenderHealth, New York. The study was supported by funding from the Bill & Melinda Gates Foundation, through the Alliance for Cervical Cancer Prevention.
The Harvard Center for Risk Analysis, part of the Harvard School of Public Health, is supported by funds from government, industry, and academia. Further information about the Center is available at www.hcra.harvard.edu.
For further information, please contact:
Director of Risk Communication
Harvard Center for Risk Analysis
Office of Communications
Harvard School of Public Health
677 Huntington Avenue
Boston, MA 02115
Dr. Sue Goldie
Assistant Professor at the Harvard Center for Risk Analysis