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Researchers Say Promising Advances Could Control Cervical Cancer in the Developing World (dateline September 30, 2008)

Researchers say that there are several promising scientific advances related to cervical cancer that they believe could help control the disease for the first time in the developing world, where 80% of deaths from the disease occur. The advances include new screening methods as well as a vaccination that targets the human papilloma virus (HPV), a major cause of cervical cancer. The researchers believe that these advances may help better control cervical cancer than traditional Pap tests, which are often expensive and difficult to administer in developing countries.

"Recent estimates indicate that if trends continue the way they are, developing countries will face a 75% increase in the number of cervical cancer cases because of growth and aging of the population in the next two decades. But it doesn't have to turn out that way," stated Professor Francesc Xavier Bosch of the Catalan Institute of Oncology in Barcelona, Spain, in an International Union Against Cancer news release. Professor Bosch and colleagues published a series of papers contained in a monograph in the journal Vaccine. The monograph prese application of the HPV vaccination and new screening methods in developing countries in the Asia-Pacific, Latin America and the Caribbean.

At an International Union Against Cancer convention in August 2008, three groups, the International Union Against Cancer, Cervical Cancer Action and PATH, launched a large, joint public education campaign. The campaign includes more than 400 letters, editorials, and other communications from developed and developing countries, global leaders, cancer control specialists and international organizations that advocate improved cervical cancer prevention in the developing world. The International Union Against Cancer also announced the launch of a series of professional training workshops on cervical cancer in developing countries, as well as funding for fellowships at leading institutions.

The Pap test is the standard screening method for cervical cancer in developed countries. However, research linking HPV to an increased risk of cervical cancer opens the door to new methods to combat the disease, according to the researchers who authored the cervical cancer monograph in the journal Vaccine. A vaccination that targets HPV is now available, and according to the researchers, could potentially be less expensive for developing countries. Their analysis found that the vaccination would be cost effective in poor countries if it could be made available for between $10 and $25 per girl in the Asia Pacific, including logistical and delivery costs. The vaccination could be cost effective in Latin America and the Caribbean if it were available for less than $25. Currently, a substantial barrier to widespread vaccination remains cost. The price of the HPV vaccine in the private sector is about $360 per girl, said the researchers. The researchers suggest a tiered pricing formula where countries could pay what they could afford for the vaccine.

In addition to the HPV vaccination, the researchers point to other alternative screening methods for cervical cancer that could be useful in developing countries. According to the International Union Against Cancer, one such method is visual inspection with acetic acid, VIA, which involves painting the cervix with vinegar. The researchers report that one large study in India showed that a significant reduction in cervical cancer diagnoses and deaths using VIA, and it is relatively inexpensive to administer.

The researchers also report that testing for HPV DNA would be helpful in developing countries. Testing kits are relatively inexpensive and easy to use, and most nurses can administer the test. "The models provide a useful roadmap for testing promising strategies in the field. More research is needed to determine an efficient combination of these new approaches and each country will have to decide which is best for them, but we are confident we have provided a valuable starting point for going forward," Bosch said in an International Union Against Cancer news release.

The International Union Against Cancer reports that about 500,000 women worldwide are diagnosed with cervical cancer and more than 250,000 die from the disease. It is the leading cancer in women in half the countries of the world and mostly affects relatively young poor women.

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