November 18, 2005
Just two lifetime health clinic visits could halve the cervical cancer risk for women in developing countries, according to a new study. Thanks to regular screenings, cervical cancer claims only around 4,000 lives annually in the United States. In the developing world, however, it is a leading cause of cancer deaths.
Lead author Sue Goldie, of the Harvard School of Public Health, and colleagues found that a test for human papillomavirus (HPV), which causes cervical cancer, would be practical in the nations they studied -- India, Kenya, Peru, South Africa and Thailand. The researchers concluded that a one-time HPV screening at age 35, combined with surgical treatment for women with an abnormal result, could cut the lifetime risk of cervical cancer by 25 to 36 percent. A second screening at age 40 would lower the risk by almost 50 percent.
The most effective test for detecting cervical cancer is the Pap smear, but it requires laboratory facilities and highly trained technicians to read the results, making it impractical for poor countries. With costs ranging from $24 to $111 per screening depending on the country, HPV testing "would be among the most cost-effective interventions available," the researchers said.
This finding "adds strong support to changing the long-standing perception that screening will be too difficult to implement and sustain in the world's poorest countries," said Goldie.
In a related commentary, Mark Schiffman and Philip Castle of the National Cancer Institute said: "Because it is feasible to prevent cervical cancer and to avert the suffering it causes so many women and their families, cervical cancer deserves to be a high priority among global efforts to prevent cancer. Within a few years, we expect to have multiple tools not only to improve cervical-cancer screening, but also to restrict the spread of its viral cause."
The study, "Cost-Effectiveness of Cervical-Cancer Screening in Five Developing Countries," and the commentary, "The Promise of Global Cervical-Cancer Prevention," were published in the New England Journal of Medicine (2005;353:2158-2168 and 2101-2104, respectively).