Factors that affect the quality of cytologic cervical cancer screening along the Mexico–United States border

Use of artemisinin and its derivatives to treat HPV-infected/transformed cells and cervical cancer: a review

ABSTRACT: 

Cervical cancer and HPV-related diseases remain a burden in the developing world. While much progress has been gained in the detection of HPV and preneoplastic cervical lesions, the rate-limiting step in the prevention of cervical cancer is management of these women. A natural compound, artemisinin, and its derivatives appear to hold promise as a simple means of treatment. Laboratory studies have shown that this compound, and its derivatives, have activity against HPV-infected and -transformed cells and cervical cancer cells. In situations of compassionate use, studies have also demonstrated efficacy in clinical situations. Well-designed clinical trials relating to its use should be undertaken.

The Mexican Cervical Cancer Screening Trial: self-sampling for human papillomavirus with unaided visual inspection as a secondary screen

The Mexican Cervical Cancer Screening (MECCS) study took place in the State of Michoacán. Primary screening was by self-sampling for high-risk human papillomavirus (HR-HPV). The objectives were to increase the specificity of primary HPV screening by requiring 2 positive HPV tests 1 year apart in women whose secondary screen was negative according to an acetic acid-aided visual inspection (VIA). In addition, we postulated that the sensitivity of VIA would be sufficient to identify large preinvasive lesions and cancers unsuitable for cryotherapy if applied in a see-and-treat algorithm.A total of 8621 women (aged 30-50 years) were screened, and 14.3% were positive for HR-HPV. In phase 1, 11.9% of the HPV-positive women were VIA-positive and were referred for colposcopy with directed and random biopsies. If VIA-negative, women repeated the self-sample 1 year later to detect persistent HR-HPV (25.2% were positive). If persistently HR-HPV-positive in phase 2, patients again had VIA, then all women (both VIA-positive and -negative) received directed and random biopsies. If cryotherapy had been used to treat HPV- and VIA-positive women in phase 1 or persistent HR-HPV-positive (phase 2), the potential risk of undertreatment would have been 4.1%, and 66.4% of the treated patients would have had normal or cervical intraepithelial neoplasia I on biopsy. The VIA triage would refer 0.73% of the patients to colposcopy owing to the lesion size, location, or the presence of a cancer. On the basis of this pilot study, we are encouraged to explore and evaluate a rapid, more sensitive, and more specific self-test.

Crossing the quality chasm: a requirement for successful cervical cancer prevention in developing countries

Disease prevention requires sociopolitical change, which in turn requires the participation of those for whom the change is intended, including demographic groups at high risk for disease, appropriate governmental authorities, and essential health care personnel. Multiparous women of lowest socioeconomic status, the demographic group at highest risk for the development of cervical cancer, lack sociopolitical leverage almost by definition. Pap screening in developing countries is an idea whose time has come, but it is also an ethical imperative currently lacking a substantial sociopolitical constituency. Noncytologic screening methods currently benefit from sponsorship by corporate manufacturers and by donor organizations such as the Bill and Melinda Gates Foundation. Pap screening efforts in developing countries will benefit from the involvement of cytology organizations based in developed countries. Future assessments of the progress of cervical cancer prevention efforts in developing countries will benefit from additional examination of the interactions between quality and sociopolitical obstacles to change. Many of these obstacles will be elucidated by following the money, as well as the science, involved in cervical screening activities.