Formal discussant Electra D. Paskett, PhD, Professor of Medicine at The Ohio State University, was enthusiastic about these trial results and the potential of visual inspection with acetic acid screening, as well as low-cost human papillomavirus (HPV) screening to save lives in the developing world.
“To develop organized screening in low-resource areas of the world, we need to maximize participation and use tests that have maximal feasibility, affordability, and sensitivity. [Visual inspection with acetic acid] is simple, inexpensive, provided by trained nonmedical personnel, accurate, and can detect more lesions likely to progress,” Dr. Paskett said.
Unique characteristics of the study were its population (previously unscreened women from the slums), large sample size, high participation rate, and its community-friendly nature based on community rapport.
“The real implications of this study are that it was done in the setting of poverty, where knowledge is poor and the relative importance of prevention is low compared with everyday survival. Disparities in health regardless of the country are caused by poverty. The health of a country is equal to the wealth of a country,” she stated.
Dr. Paskett suggested that the next study could be a comparative effectiveness study of visual inspection with acetic acid vs low-cost HPV screening. “A study done in rural China established the accuracy of low-cost HPV screening, administered by inexperienced but trained workers.1 Such a study could be done in a low-resource country if embraced by the community,” she commented.
“Can we conquer cervical cancer? I think we can, but we need to address this in the setting of poverty, where the greatest burden of this disease occurs. I’m going bigger than Dr. Shastri. I think we could save 250,000 lives each year,” Dr. Paskett told listeners. ■
Disclosure: Dr. Paskett receives grant funding from Merck.
Reference
1. Li N, Ma CP, Sun LX, et al. Evaluation on the visual inspection with Lugol’s iodine in cervical cancer screening program. Zhonghua Liu Xing Bing Xue Za Zhi 27:15-18, 2006.
