A new study led by Columbia University Medical Center researchers demonstrates the safety and efficacy of two low-tech diagnostic tools to significantly reduce the prevalence of cervical cancer precursor lesions. Cervical cancer is the leading cause of cancer-related death in women in many developing countries.
Designed as rapid screen-and-treat methods that could be done the same day, the protocols could finally make prevention of cervical cancer a viable option for all women in any setting around the world.
The two screen-and-treat methods, human papillomavirus (HPV) DNA testing and visual inspection with acetic acid (VIA), followed by treatment using cryotherapy for all eligible women with positive test results, were found to perform as well or better than traditional cytology-based screening (Pap smear) for identifying high-grade cervical cancer precursor lesions. Cryotherapy – freezing the cervix – is a relatively low-technology treatment method that has been shown to be highly efficacious with minimal morbidity. This study was the first time these methods were tested for efficacy in reducing the prevalence of cervical cancer precursor lesions.
"These are highly effective, low cost methods to reduce the unnecessary mortality from cervical cancer around the world – especially in the world's poorest countries," said Thomas C. Wright Jr., M.D., principal investigator of the study and professor of pathology, Columbia University College of Physicians & Surgeons. "We found that conducting HPV DNA or VIA protocols in South Africa were not only much more cost-effective than traditional cytology-based approaches, but were similar in overall cost to other well-accepted health interventions, such as childhood vaccines."
Published in the Nov. 2, 2005 issue of the Journal of the American Medical Association, the randomized clinical trial included 6,555 nonpregnant women, aged 35 to 65 years, between June 2000 and December 2002 at three ambulatory women's health clinics in Khayelitsha, South Africa. All women were screened using HPV DNA and VIA testing. Women were subsequently randomized to one of three groups: cryotherapy if the woman had a positive HPV DNA test; cryotherapy if the woman had a positive VIA test; or to a delayed evaluation group.
The women returned after six and 12 months for follow-up exams. Both the HPV DNA and VIA testing followed by cryotherapy reduced the prevalence of cervical cancer precursor lesions, or CIN 2+. After six months, a 77 percent lower prevalence of CIN 2+ was found among the HPV group compared with the delayed evaluation group and a 37 percent lower prevalence among the VIA group compared with the delayed evaluation group.
"This novel approach to cervical cancer prevention is highly acceptable to the women in the community," said Lynette Denny, M.D., MPH of the University of Cape Town in South Africa who directed the clinical activities in Cape Town. "Ninety-nine percent of participants said they would recommend this type of screening program to friends and family."
"The next step is to conduct large-scale public health intervention projects to better define the operational needs and challenges of these programs," said Dr. Wright.