Pathways to Prevention: Choosing the Right Cervical Cancer Test

By Minal Bopaiah, Communications Manager, PSI

Many women are familiar with the uncomfortable but necessary Pap smear – a common procedure that screens for cervical cancer. The Pap smear involves scraping cells from a woman’s cervix and then sending it to a lab for analysis. Because the procedure requires specialized medical training and complex diagnostic facilities, it’s not very cost-effective or scalable for the developing world.

But did you know there are other screening options that are becoming more readily available to women today?

A genetic test for HPV – the virus that causes cervical cancer – can be used to detect cancer-causing strains of the virus, and pilot studies have shown that HPV DNA samples can be self-collected by women, a benefit that offers additional privacy and convenience to clients.

The visual inspection with acetic acid (or VIA) screening test can easily be administered by paramedical professionals at a clinic.

Since one-quarter of all cervical cancer cases are in India, PSI-India was motivated to find an appropriate alternative to traditional Pap Smear testing. Using the WHO decision tree below, PSI-India determined that the VIA test would be the most cost-effective and scalable. (While the HPV genetic test is recommended over a Pap smear, it’s still cost-prohibitive for many settings.)

 

WHO guidelines on cervical cancer screening, crytology, visual inspection with acetic acid

In partnership with Kathy Vizas, a PSI-affiliated philanthropist with a passion for helping girls and women in developing countries, PSI-India launched a low-cost “screen and treat” program in 2014 among 80 private sector health providers in three districts of India’s Uttar Pradesh (UP) State.

Women can get screened at “women’s health screening programs,” which are advertised by wall paintings, outreach coordinators and word-of-mouth. Women in need are also able to get treated using cryotherapy – a procedure that “freezes” any suspicious-looking cervical cells before they can become cancerous.

The pilot program has screened over 12,500 women to date. Thus far, roughly half (47%) of women in need of treatment agree to cryotherapy right away. For those who do not seek immediate treatment, PSI health workers regularly follow-up to encourage women to return for treatment, either at a private sector clinic or through the public sector, where cryotherapy services offered for a nominal fee.

“The cost of treatment is the biggest obstacle,” said Dr. Nayanjeet Chaudhury, PSI-India’s Director of Monitoring & Evaluation and Health Services Delivery. “In addition, women often have to go seek permission and financial support from their families before getting treated.”

But the program does present an opportunity to provide more comprehensive care to rural and urban populations in India. Currently, PSI-India is exploring options for providing women with five critical health screens in one visit:

  1. VIA screening for cervical cancer
  2. BMI to determine nutritional status
  3. Blood pressure screening for hypertension
  4. A hemoglobin test for anemia
  5. Blood sugar testing for diabetes

PSI plans to launch five pilot programs providing this comprehensive service to women in Indian in the districts of Lucknow, Varanasi, Kanpur Nagar, Gorakhpur, and Kannauj. The hope is to leverage the power of public-private partnerships to scale up the program to serve 28 districts.

 

For more information regarding PSI’s work in cervical cancer control and prevention, contact Dr. Heather White at hwhite@psi.org. For more details on PSI’s philanthropic partner program, contact Jen Haile at jhaile@psi.org.