Cervical cancer is the most common cancer among women in many developing countries, where 85% of the estimated 493,000 new cases and 273000 deaths worldwide occurred, based on figures from 2002.
Dr Rengaswamy Sankaranarayanan, International Agency for Research on Cancer, Lyon, France and colleagues, did a study of 49311 apparently healthy women aged 30-59 in the Dindigul district of India, of which 31343 were screened for cervical cancer. A further 30958 women acted as a control group. The screening method used was VIA - a visual inspection using a speculum (the tool used to take a smear) and bright halogen focus lamp, after application of 4% acetic acid solution to the cervix. The presence of acetowhite lesions or areas close to the squamocolumnar junction of the cervix was indicated a positive VIA result; no such lesions or areas gave a negative VIA result.
The researchers found that 3088 (almost 10 per cent) of the women screened gave a positive VIA result, of which 3052 underwent colposcopy (further, closer examination of the cervix tissues) and 2539 had directed biopsy. A total of 1874 were found to have precancerous lesions, 72% of whom received treatment. In the intervention group (49311 women), a total of 167 cervical cancer cases and 83 cervical cancer deaths were recorded; in the control group (30958 women), 158 cases and 92 deaths were recorded. Women in the intervention group were 25% less likely to develop cervical cancer and 35% less likely to die from the condition compared with the control group.
The authors conclude: “VIA screening, in the presence of good training and sustained quality assurance, is an effective method to prevent cervical cancer in developing countries.”
In an accompanying Comment, Dr Anne Szarewski, Wolfson Institute of Preventative Medicine, London, UK say that other studies suggest that addition of Lugol’s iodine staining can improve the sensitivity and specificity of VIA, making it easier to learn and use.
She says: “In the long term, HPV vaccines will probably offer the greatest hope for cervical cancer prevention in all countries. However, for those without current screening programmes, perhaps VIA, but together with iodine staining, will be the way forward in the near future.”
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