Cervical Cancer Screening Test Studied in Peru

The project, TATI-2, will evaluate the population effectiveness of cervical cancer screening using visual inspection with acetic acid (VIA), a rapid-results procedure designed for use in low-resource settings such as those found in developing countries. VIA is an alternative to the Pap smear, the most widely used method of screening for cervical cancer among women in industrialized countries.

Cervical cancer rates have not declined significantly in the PAHO region despite the widespread use of Pap smear screening. Silvana Luciani, project manager in PAHO's Noncommunicable Diseases unit, cites three primary reasons. First, existing programs do not reach enough women in the at-risk age groups. "Effective programs need to reach a high proportion of women aged 30 years and older," explains Luciani. Second, women who screen positive may not receive adequate follow-up diagnosis and treatment for their condition.

"In some cases it is because women never return to obtain their screening test results, in other cases because they don't seek follow-up care because they cannot afford it or it's not available anywhere near where they live."

In other cases, the quality of the Pap smear is poor, and precancerous lesions are not accurately detected.

The first phase of the TATI project screened more than 36,000 women and compared the effectiveness of the Pap smear with VIA and two other screening methods. The results showed that VIA had a higher sensitivity but poorer specificity than the Pap smear performed locally.

In TATI-2, researchers will obtain longitudinal data on 12,100 women in Peru's San Martin region to examine the outcomes of screening with VIA, in terms of its technical effectiveness as well as other factors that influence its population effectiveness. These include characteristics of health services delivery and the social and health characteristics of women. The results are expected to shed light on ways to ensure optimal quality of VIA with long-term use in low-resource settings, including how to organize health services to ensure quality among multiple health providers.

The results of the study, expected to be available by 2008, will be shared first with authorities from Peru's Ministry of Health and the San Martín Regional Health Authority. The findings will then be disseminated by PAHO through scientific publications. The results will also be used to support advocacy efforts in Latin America and the Caribbean for strengthening cervical cancer prevention programs.

TATI-2 is part of the work of the Alliance for Cervical Cancer Prevention, an international partnership consisting of Engender-Health, the International Agency for Research on Cancer, JHPIEGO, PAHO, and PATH. Funding is provided by the Bill and Melinda Gates Foundation through the Alliance.