New cervical screening method could save women’s lives in low-income countries
Study in South Africa and Burkina Faso shows that simple HPV screening could help save lives in places with limited health infrastructure.
A project investigating how to increase the effectiveness of cervical cancer screening in South Africa and Burkina Faso, with a focus on women living with HIV, has found evidence which could help improve screening, and save lives, in resource-poor countries.
Cervical cancer is caused by human papillomavirus (HPV) infections, the most common sexually transmitted infection. In healthy women, HPV infection usually takes 10 to 15 years to create lesions which are precursors to cancer. Women living with HIV are not only more vulnerable to persistent HPV infections, but are also likely to develop pre-cancerous lesions more quickly – within six to seven years.
Approximately 80% of cervical cancers worldwide occur in developing countries, where cervical cancer accounts for 15% of female cancers compared with just 3.6% in developed countries.
As part of the HARP project, researchers investigated the effectiveness of different methods of cervical cancer screening. The study compared HPV DNA testing, which looks for the presence of DNA belonging to cancer- causing HPV, with other types of screening, including visual inspection of the cervix (traditionally carried out by trained nurses), and analysis of cervical cells (cytology) collected by a smear test (Pap smear).
The HPV DNA test is relatively new. A simplified and cheaper version of the test has been specifically developed for use in low resource settings. It is easy to set up and no highly specialised knowledge is required to analyse samples. This makes it particularly appropriate for low-income countries, where specialised medical and laboratory facilities are often few and far between.
The results varied between the countries reflecting differing HIV and HPV infection patterns.
- Younger women between 25 and 29 years of age had the highest rate of cancer precursor lesions. This suggests that starting screening at a younger age, especially for those living with HIV, would help diagnose more women in time for treatment.
- In South Africa, cytological analysis was found to be an effective screening method.
- In Burkina Faso, an HPV DNA test combined with a visual inspection could be more useful.
- Almost one quarter of participants in South Africa (22%) had a lesion that should be treated. The percentage in Burkina Faso was much lower at around 5%.
- The high HPV prevalence in South Africa meant the HARP team recommended HPV vaccination for young women living with HIV.
These findings are already shaping cervical cancer screening programmes in other countries in sub-Saharan Africa.
“HPV screening is a new thing for Africa,” explains Philippe Mayaud, HARP project coordinator at the London School of Hygiene & Tropical Medicine.
“The lessons we learnt from Burkina Faso, we managed to transfer to Ghana, another country in West Africa. Ghana has now performed a study looking at HIV-positive and HIV-negative women, comparing cytology and HPV screening. The results seem to be in favour of HPV screening for both groups.”