The rate of cervical cancer cases is far greater in less developed countries where women do not have adequate access to healthcare, and particularly to screening with Pap tests. In an effort to reduce the number of cases and deaths from cervical cancer, researchers are exploring whether low technology tests involving visual inspections of the cervix, and treatment with cryotherapy, a procedure that involves freezing cancer cells to destroy them, would be more practical alternatives to Pap tests and surgeries for women who are not likely to receive detailed follow up care. Preliminary results are promising.

In the United States, the increased use of the Pap test (also called Pap smear) is largely responsible for the significant reduction in the number of deaths from cervical cancer over recent years (a decrease of 74% from 1955 to 1992). Approximately 50 million Pap tests are performed each year in the United States. When detected early, the five-year survival rate for cervical cancer is approximately 91%. If cervical cancer is detected before it has invaded any surrounding tissues, the five-year survival rate is nearly 100%.

However, survival rates for cervical cancer are much lower in less developed countries where routine screening is not widely available. To increase screening and treatment of cervical cancer in these countries, Dr. Lynne Gaffikin of the Cervical Cancer Prevention Programme of JHPIEGO Corporation, an affiliate of Johns Hopkins University, and colleagues are investigating alternatives to Pap tests and surgery to remove cervical cancer tumors.

Dr. Gaffkin and her colleagues deployed 12 trained nurses to provide low technology services in mobile (village health centre-based) and static (hospital-based) teams in four districts of Roi-et Province, Thailand. The low technology services included visual inspections of the cervix using an acetic acid wash (VIA), a low cost assessment tool. Those women who tested positive for cervical cancer received counseling about the benefits, potential risks, and probable side-effects of treatment with cryotherapy.

In the United States, cyrosurgery is commonly used to treat pre-cancerous cervical conditions (such as cervical neoplasia) before they have a chance to develop into cervical cancer. The procedure may also be used to treat early-stage cervical cancer. Cryotherapy involves freezing cervical cancer tissue to destroy it.

Cryotherapy was offered as an alternative to surgery to the women in the study because of the quick nature of the procedure and less extensive follow up (in the U.S., cryosurgery is typically performed in a doctor’s office). In the study, 94% of the women who received cryotherapy for cervical cancer tested negative for cancer after one year, suggesting that the treatment is a viable alternative for women in less developed countries. The researchers conclude that "a single-visit approach with VIA and cryotherapy seems to be safe, acceptable, and feasible in rural Thailand, and is a potentially efficient method of cervical-cancer prevention in such settings."

The most common side effect of cyrosurgery is mild cramping; severe discomfort does not usually occur. Women are typically able to resume normal activities immediately after the procedure, although they are usually advised to refrain from sexual intercourse and douching for several weeks after surgery.

In the United States and other developed countries, there are several treatment options for cervical cancer, including cryosurgery, cauterization, laser surgery, cone biopsy, simple hysterectomy, radical hysterectomy, pelvic exenteration, radiation therapy, and chemotherapy. Click here to learn more about these treatment options. 

Additional Resources and References

• The report, "Safety, Acceptability, and Feasibility Of a Single-Visit Approach to Cervical-Cancer Prevention in Rural Thailand: A Demonstration Project," is published in the March 8, 2003 issue of The Lancet, http://www.thelancet.com/
• To learn more about cervical cancer, please visit http://www.imaginis.com/cervical-cancer/