TUESDAY, Nov. 1, 2005 (HealthDay News) -- A "one-stop-shopping" approach to cervical cancer screening, diagnosis and treatment is both safe and effective for women in the developing world, and may even lower death rates for low-income American women, two new studies show.
What's more, researchers say screening, diagnosing and treating women in one visit could reduce the death rate from cervical cancer in poorer countries to levels close to those of more affluent nations.
The findings appear in the Nov. 2 issue of the Journal of the American Medical Association.
Thanks to widespread cytology (cell-based) screening such as the Pap smear, the incidence of cervical cancer has dropped dramatically in developed countries over the past few decades.
That hasn't been the case in less-developed countries, however. In fact, 80 percent of cases of cervical cancer worldwide now occur in these resource-poor areas, where women have access to less than 5 percent of global cancer treatment resources.
In these countries, cervical cancer remains the leading cause of cancer deaths among women. As the authors of an accompanying editorial state, "the majority of cervical cancer cases worldwide occur among women who are never screened or treated."
And while non-cytology approaches to screening have been developed, it's unclear how safe or effective they are.
"The optimal way to screen is the Pap smear. Unfortunately, it's just not possible in some underserved areas, including in our own country," said Dr. Kevin Holcomb, director of gynecologic oncology at Beth Israel Medical Center in New York City. "We need creative alternatives. Both these studies show that we can devise alternatives proven to be effective."
The first study involved 6,555 women aged 35 to 65 in Khayelitsha, South Africa. All women were screened using two non-cytology-based assays: DNA testing for human papillomavirus virus (HPV), the virus which causes cervical cancer, and visual inspection with acetic acid (VIA).
Participants were then randomized to one of three groups: cryotherapy (if the women had a positive HPV DNA test), cryotherapy (if the woman had a positive VIA) or delayed evaluation and treatment. Cryotherapy involves the freezing off of suspect lesions.
At the end of one year, women in both screened-and-treated groups had a lower prevalence of precancerous lesions and cancer than women in the delayed evaluation group: 1.42 percent of women in the HPV DNA group (a 77 percent reduction), 2.91 (a 37 percent reduction) percent in the VIA group and 5.41 percent in the delayed-evaluation group.
Although many women complained of discharge and bleeding, major complications were rare.
Dr. Thomas C. Wright Jr., senior author of the study and a professor of pathology at Columbia University in New York City, said that VIA screening could take effect in the near-term in poorer areas, while HPV DNA testing might take a little longer to introduce.
Almost all (99 percent) of participants in the study said they would recommend this screen-and-treat approach to family and friends.
A vaccine against HPV should be available within the next year, Wright noted, but this will not necessarily change the importance of screening.
"We would marry primary and secondary prevention, using screening-and-treatment for the older patients and vaccinating their daughters," he said.
"The problem is you really need to vaccinate prior to exposure, and exposure occurs very shortly after onset of sexual activity," he added. "You're going to have two decades of women who will not have access to the vaccine and because they've already been exposed, we're talking millions of women who will die of cervical cancer without doing something."
A second study suggests that informing low-income American women of their diagnosis at the same time they undergo a Pap smear could improve outcomes.
According to experts, most cervical cancers in the United States occur in women who have never had a Pap smear or, for whatever reason, do not follow up when they receive abnormal results.
The study, conducted by a team from the University of California, Irvine, tracked the health of a group of over 3,500 low-income women in California who received an abnormal Pap test result. Half of the patients were sent home to await the results of their test, while the other half waited at the clinic to receive their diagnosis at the time of screening.
The single screen-and-diagnose visits averaged 2.8 hours from beginning to end.
That wait may have saved lives: according to the researchers, 53 percent of the women in the usual, delayed-diagnosis group received appropriate treatment within six months, compared with 88 percent of women in the single-visit, screen-and-diagnose group.
Sixty-three percent of women in the single-visit group also turned up for a follow-up Pap test one year later, compared with just 21 percent of women in the usual-care group.
Screening and diagnosing low-income women in the same visit may improve outcomes by easing some of the financial pressures patients face. "It's a question of how you handle the results. Do you send a letter and then require the woman to take another day off work?" Holcomb said.
Such a procedure could only work if it were reserved for women who had severely abnormal tests results, he added. "If you did it with all women, it would be a lot of unnecessary work," Holcomb said.
More information
To learn more about cervical cancer, visit the National Cancer Institute.
