January is Cervical Cancer Awareness Month—perhaps the only time of the year that people in Europe and North America give even a passing thought to a disease that, in many low-income countries, kills more women than any other type of cancer. Cervical cancer has been part of my work at PATH for more than 20 years. And while it still takes far too many lives, I’m encouraged by the progress we’ve made against a disease that vaccination and screening have made preventable.
Twenty years ago, evidence was just beginning to conclusively show that the human papillomavirus (HPV) is the underlying cause of cervical cancer. Yet, there was no vaccine against HPV. And the Pap screening test, which most women in wealthy countries take for granted, was almost unknown in the countries where nearly nine of ten cervical cancer deaths occur.
A simpler way to stop cancer
Back then we knew that even though screening a woman just once in her lifetime significantly reduces her risk of cervical cancer, taking Pap worldwide would be nearly impossible. Pap tests require sophisticated labs with microscopes, slides, stains, and trained pathologists. Getting busy women who might live hours away to come to a clinic every few years to be tested—and if necessary to return several times before treatment could begin—would be a major challenge in regions with so many demands on health services.
Beginning in the 1990s, research by PATH and our partners suggested that a simpler test, called visual inspection with acetic acid (VIA), could work even better than Pap for identifying cervical precancer, a condition that can be easily and successfully treated at low cost. And we knew that curing precancer prevents actual cervical cancer from ever developing.
Building the evidence
It took a while to convince people in public health about VIA. Many were skeptical that a simple procedure—swabbing the cervix with vinegar and looking for discolored areas to treat—could make a difference.
So, PATH and our partners in the Alliance for Cervical Cancer Prevention carefully built up the evidence over nearly a decade. We proved that VIA was both effective and feasible in even the poorest rural settings. More groups began to take up the idea, and more countries began to try it out.
Begin with VIA
What a different world we’re in now. Ten years ago VIA was considered experimental. Five years ago it was talked about as a viable option. But now, experts in global health say that countries that don’t have screening programs should begin with VIA.
As VIA and treatment services expand, they will make a huge difference in curbing cancer rates, as will the rollout of vaccination against HPV. And soon, availability of highly sensitive HPV DNA testing, which can be added to VIA services, will again revolutionize cervical cancer prevention as it identifies women who are infected with the most dangerous types of HPV, enabling them to be treated before cancer develops.
Now we need to make sure that countries make these advances available to all girls and women who need them. Our goals for the next 20 years should include making screening a part of routine women’s health services in Africa, Asia, Latin America—everywhere—so that no woman dies needlessly from a cancer we can prevent from ever developing.
- Vivien Tsu is an associate director in the Reproductive Health Program at PATH.