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ACCP presenters Jacqueline Sherris (PATH), Rengaswamy Sankaranarayanan (IARC),
Silvana Luciani (PAHO), and Harshad Sanghvi (Jhpiego)

ACCP symposium on “10 Key Findings and Recommendations for
Effective Cervical Cancer Screening and Treatment”

ACCP partners Sharone Beatty (EngenderHealth) and Jacqueline Sherris discuss findings with Rebecca Fields from John Snow, Inc.’s IMMUNIZATIONbasics project.

Washington, DC

On March 5, 2008 the Alliance for Cervical Cancer Prevention (ACCP) partners sponsored a symposium to explain key findings and recommendations resulting from eight years of studies in over 20 countries in Africa, Asia, and Latin America. At the top of the list: early identification of precancer using simple, visual inspections of women is as effective as technically difficult and expensive Pap testing. Furthermore, highly sensitive, affordable human papillomavirus (HPV) -DNA tests could become widely available in the next few years, increasing our options.

The meeting was well-attended, with representation from over 30 diverse organizations including the American College of Obstetricians and Gynecologists, the American Social Health Association, the Association of Reproductive Health Professionals, Cervical Cancer Action, the Global Summit of Women, the Guttmacher Institute, the International Women’s Health Coalition, the National Organization for Women Foundation, the Office of US Representative Carolyn Maloney, the US Department of State Office of the Global AIDS Coordinator, Women in Government, the World Bank, and the World Health Organization, among others.

A fact sheet summarizing the key findings can be downloaded here. A peer-reviewed paper detailing the evidence behind the findings will be published later this year. Following are some of the key points made by four ACCP scientists.

Sarah Goltz Shelbaya of the advocacy group Cervical Cancer Action was one of many participants actively engaged in discussion.Dr. Jacqueline Sherris of PATH noted that “cervical cancer represents a huge global inequity with a heavy burden on poor women. It is an awful disease that shatters families by taking women at the peak of their productive lives, when they are in their forties and fifties. Often, and especially in communities with large numbers of AIDS orphans, these grandmothers and aunts play a crucial role in raising children and maintaining social cohesion.”

Dr. R. Sankaranarayanan of the International Agency for Research on Cancer has studied alternatives to Pap smear screening in India and other countries. He explained that cervical cancer is easy to treat if precancerous signs are detected early. Treatment in low-resource settings often can be done using a device that destroys the affected tissue by freezing, the same way that common warts are frozen.

For the visual screening methods tested by the ACCP, a trained health worker swabs the patient’s cervix with vinegar (a painless procedure). After one minute, any small lesions on the cervix—signs of potential future cancer—can be seen with the naked eye. “In most cases it is possible to treat the women for precancer during the same visit to the clinic,” says Dr. Harshad Sanghvi of Jhpiego. “This is important because if a woman is sent home the day of the exam, and asked to come back days or weeks later to hear the results and be treated, she may not be able to return. In the past, many women have missed the care they needed for this reason. Treatment in the late stages of cervical cancer—when women suffer symptoms—is difficult and often not successful. We need to screen all women, beginning at age 30, and provide rapid treatment to those who need it.” And once HPV tests become widely available, they can be used along with visual inspection to design optimal, cost-effective prevention strategies that can reach all women who need them.

"New technologies for cervical cancer prevention are revolutionizing public health,” according to Silvana Luciani of the Pan American Health Organization. “Visual screening methods, high-tech DNA tests for HPV and the new HPV vaccines represent incredible opportunities to strengthen prevention. We need to protect girls from HPV infection with vaccine, but immunization is not a substitute for screening. Screening programs are needed to care for women who may have already been infected with HPV, because the vaccine does not protect them effectively and there are cancer-causing types of HPV not targeted by the vaccine. Research indicates that a combination of vaccination and screening can dramatically reduce cervical cancer deaths in the coming decades.”

In her closing remarks, Dr. Sherris challenged US and European donors and policymakers to take a leadership role in improving cervical cancer screening and HPV vaccination worldwide: “Every woman has the right to screening at least once in her lifetime, and girls have the right to HPV vaccination. This is our goal, and it is achievable."

Photos: Tim Staffa and Janina Kaplan

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