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Studies Offer New Hope for Reducing Cervical Cancer Deaths (2013-06-07)

 

A pivotal study was released ahead of the plenary session of the 49th Annual Meeting of the American Society of Clinical Oncology (ASCO). Effective, affordable cervical cancer screening strategy promises to save thousands of women’s lives in low-income countries: A major clinical trial in India conducted among 150,000 women conducted over a period of 15 years demonstrates that biennial cervical cancer screening using visual inspection with acetic acid (vinegar) delivered by trained primary healthcare workers is effective and can be implemented on a broad scale.

The approach reduced cervical cancer death rates by nearly one-third, and researchers estimate it could save 22,000 lives in India and 73,000 worldwide every year.
“Today’s results show that progress can happen at both ends of the technology spectrum, from cutting-edge drugs to the simple use of vinegar to detect cervical cancer,” said moderator and ASCO spokesperson Jyoti Patel, MD, an oncologist at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago, Ill.
Cervical cancer is the leading cause of cancer death among women in many developing countries, where there is little or no access to Pap screening.

The VIA test is performed by applying vinegar to the cervix using a cotton swab. After 60 seconds, the cervix is examined with the naked eye using a lamp. Pre-cancerous tissue turns white when vinegar is applied, whereas healthy tissue does not change color. The results are known immediately, a very important advantage in rural areas where women might otherwise have to travel for hours to see a doctor.

Researchers trial used primary healthcare workers who can easily access women in the community, which is critical in India and other countries that lack sufficient nurses, physicians, and laboratory facilities.

In this study, women aged 35-64 years with no prior history of cancer were randomly assigned to biennial screening with VIA (75,360 women) or no screening (76,178 women), which is the current standard of care in India given that the infrastructure does not allow for country-wide Pap screening. According to the authors, in accordance with international standards for clinical research – including cancer screening trials – interventions are tested against the local standard of care.

The control group received one round of cancer education, at enrollment. Women in the control group were asked to report to the primary health workers any signs/symptoms of cervical cancer that they noticed on the basis of what they had learnt during the initial cancer education sessions. The health workers then directed them to the Tata Memorial Hospital (where they received diagnosis and treatment at no cost) or to other nearby facilities of their choice.
The screening group received four rounds of VIA screening and cancer education at 24-month intervals between 1998 and 2010. All trial participants were offered free cervical cancer treatment, if diagnosed.

The incidence of invasive cervical cancer was comparable in the two groups, (26.7 per 100,000 in the screening group and 27.5 per 100,000 in the control group), suggesting that screening did not lead to overdiagnosis.
Screening with VIA resulted in a 31 percent reduction in cervical ancer-specific death rates (11.1 and 16.2 per 100,000, respectively).
There was also a seven percent reduction in the overall death rate, because cancer was often diagnosed at an earlier stage in the screening group, although the difference in the overall death rate was not statistically significant.

In 1996, around the time this study was initiated, the Indian Council of Medical Research estimated that, even if the number of existing Pap smear facilities in India were multiplied 12 times, they would only be able to provide a single round of screening to 25 percent of eligible women in 10 years.
Previous studies have suggested VIA is a reasonable alternative to Pap smears or HPV DNA testing for its low cost and ease of use.

Two randomized population-based clinical trials of VIA screening were conducted in parallel with the present study in India but the strategies proposed in those studies are not implementable at the national level due to their requirement for trained nurses or sophisticated laboratory facilities. 
In the first study, a single round of VIA screening provided by trained nurses led to reduced cervical cancer mortality.
The second study compared four cervical cancer prevention strategies: primary health workers delivering a single round of VIA screening, technicians delivering a single round of HPV DNA testing, technicians delivering a single round of Pap screening, and cancer education.

That study found that a single round of HPV DNA testing reduced cervical cancer mortality, but a single round of VIA screening by primary health workers did not, nor did a single round of Pap testing.

The study was supported in part by the National In stitutes of Health and Women’s Cancer Initiative.

For more information
American Society of Clinical Oncology (ASCO)

(MDN)

 


L'armadietto omeopatico casalingo
(del Dott. Turetta)
Quali sono i problemi o le disfunzioni che possono giovarsi di un intervento omeopatico d'urgenza e, di conseguenza, come dovrebbe essere un ideale armadietto medicinale omeopatico casalingo.


A cura di: Dott.ssa S.Cavalli, Dott. L. Colombo, Dott. U. Zuccardi Merli
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