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With whatever resources are available for cervical cancer prevention, our mission is to improve health outcomes as rapidly as possible among as many women as possible 

Pap Screening in Developing Countries: An Idea Whose Time Has Come PDF Print E-mail

Before Papanicolaou screening (more often called “Pap screening”) became widely available in the United States, cervical cancer was the #1 cause of cancer-related death among American women. According to the widely-respected U.S. Preventive Services Task Force, Pap screening reduces cervical cancer rates by 60%–90% within three years of its introduction to previously unscreened communities, and these reductions of suffering and mortality are “consistent and equally dramatic across populations."

Today, cervical cancer remains a leading cause of death in many developing countries because of low coverage rates by Pap screening services for women in these settings. The purpose of this website is to share what we’ve learned from successful cervical cancer prevention in Vietnam, in case the information is useful to others.

We first visited Vietnam in January 1994. During that first visit, our Vietnamese friends and colleagues presented us with data documenting that the burden of cervical cancer was five-fold higher in southern Vietnam, compared to northern Vietnam. In 1996, we helped conduct a scientific study, sponsored by Stanford University, which documented that
the burden of cervical cancer in Vietnam was associated with troop movements during the Vietnam War. We delayed publication of culturally sensitive data linking war to disease for 8 years in an effort to ease the process of reconciliation by presenting what most would acknowledge to be a remedy in advance of what some will perceive to be an accusation. In 1996, we founded the Viet/American Cervical Cancer Prevention Project as an all-volunteer 501(c)(3) non-profit organization. Everyone involved with our organization works for free.

Beginning in 1995, we facilitated the introduction of Pap screening to Vietnam. The strategy used to pursue successful cervical cancer prevention was to increase consumer demand for Pap screening services while lowering their price. Cervical cancer rates in Vietnam decreased by 50% between 1998 and 2003, making Vietnam one of the first contemporary developing countries to achieve decisive large-scale success in the global struggle against this life-threatening disease.

Here are
the 5 most important lessons we’ve learned from Vietnam:

1. Opportunity costs, borne most gravely by those least privileged, are associated with prioritizing research on novel health interventions in any setting where established health interventions are feasible but unavailable.

2. Root cause analysis shows that real-world obstacles to successful cervical cancer prevention involve people far more than technology.

3. It’s unlikely that more recent technological innovations (such as human papillomavirus (HPV) tests and HPV vaccines) will substantially improve on the performance of Pap screening for cervical cancer prevention.

4. Pap screening is feasible anywhere cervical screening is appropriate, and Pap smears will remain an essential technological component of all effective preventive solutions to the problem of cervical cancer.

5. HPV vaccines will probably require booster doses, yet nonetheless may eventually fail to prevent cancer and, in the worst case, may do harm.

Taken together, here’s what these 5 lessons mean to us:

If our mission
 is to improve health outcomes as rapidly as possible among as many people as possible, then Pap screening (with or without HPV screening) must be implemented without further delay in any setting where cervical screening is appropriate but unavailable. Consideration must be given to HPV vaccination after, rather than before, full coverage of target demographic groups by screening services has been achieved and/or the possibility has been excluded that HPV vaccination may be ineffective for cancer prevention.

Our viewpoint is not shared by many global health organizations, because few global health organizations share our mission of improving health outcomes as rapidly as possible among as many people as possible. We’ve invited leaders of influential global health organizations to embrace, in their mission statements, the goal of improving health outcomes as rapidly as possible among as many people as possible.

We believe the world will become a better place if they do. 

Eric J. Suba M.D.
President and Executive Director
The Viet/American Cervical Cancer Prevention Project

Stephen S. Raab M.D.
The Viet/American Cervical Cancer Prevention Project

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