Health officials working across Latin America and the Caribbean are recommending a new method of cervical cancer prevention they say is a simpler and more cost-effective alternative to the traditional Pap smear in certain regions of the world.

At a June 19 briefing in Washington, D.C., Pan American Health Organization officials briefed members of Congress on the new “screen and treat” cervical cancer method. The method involves visual inspection to detect abnormal cervical cells followed by immediate treatment using cryotherapy to remove precancerous cells. PAHO pointed to studies showing that just one screening at age 35 resulted in a 30 percent reduction in mortality due to cervical cancer and that two screenings at ages 35 and 40 resulted in a 70 percent reduction.

PAHO researchers partnered with the Alliance for Cervical Cancer Prevention, which tested the screen and treat method in Peru, El Salvador and Suriname from 2000 to 2004, and found successful follow-up rates among women who underwent the new prevention method. The study, which yielded positive results, involved training health care providers in visual inspection and cryotherapy treatment, boosting community education efforts to increase women’s participation and integrating the method into routine primary health care services. In Peru, for example, while 75 percent of women in a prior study of cervical cancer prevention and detection methods did not follow up with treatment, only 10 percent did not receive follow-up treatment under the screen and treat method.

The results of the study are promising, PAHO officials said, as cervical cancer claims an estimated 39,000 lives in the Americas each year, representing a yearly economic loss of $3.3 billion per year in the region.

Members of PAHO said that the organization now plans to increase efforts to launch the screen and treat method in five Latin American and Carribbean countries with the highest burden of disease — Haiti, Bolivia, Nicaragua, Honduras and Guyana. The organization aims to screen 3.5 million women ages 30 to 49 and treat an estimated 300,000 women immediately with cryotherapy.

Cervical cancer is the second most common type of cancer among women according to a report from the World Health Organization. More than 250,000 women died from the disease in 2005, the vast majority in developing countries. Over the next ten years, deaths from cervical cancer are projected to rise by almost 25 percent, WHO reported.

Women in Latin America and the Caribbean are four-and-half times more likely to have cervical cancer than women in the United States and Canada, and seven times more likely to die of the disease, PAHO reported. Challenges in the region include a “lack of information” and a “lack of systems to distribute information to poor and disadvantaged women,” said U.S. Rep. Silvestre Reyes, D-Texas, at the June briefing.

The disproportionate burden of disease in Latin America and the Caribbean is particularly concerning because “this disease is almost entirely preventable,” noted PAHO Director Mirta Roses Periago, MD.

While the Pap smear is the most common screening method for cervical cancer — leading to significant reductions in mortality rates in the United States — it has failed to produce the same results in Latin America and the Caribbean, PAHO reported. In addition to the high percentage of false-negative Pap tests, challenges include women’s lack of awareness that cervical cancer is preventable, fears of visiting a doctor or embarrassment of undergoing a gynecological exam.

“The concept of going to seek medical attention when you don’t have any signs or symptoms — that is seeking preventive care — is sometimes not common,” said Silvana Luciani, MHSc, project manager in PAHO's Noncommunicable Diseases Unit.

The treatment process may also be complicated, as multiple tests are required to follow up with women who have abnormal test results. Particularly in rural areas where transportation to health centers is scarce or care is only offered at specific times, women may be less likely to return for follow-up services, PAHO officials said.

PAHO members said the Pap smear is still a useful tool for cervical cancer prevention, but they stressed the need for “screen and treat” as an important additional method.

In Latin America and the Caribbean, Periago stressed the importance of early screening and detection and of simplifying the treatment process.

 “We need to bring women into health facilities by having gender-friendly services, by helping them to overcome obstacles in their families and communities and by not having too many steps in the treatment process,” she said during the briefing. “Within each of these steps we are losing women and when we find them again it is too late, too costly, too painful.”

While the recently introduced human papillomavirus vaccine, known commercially as Gardasil, has been shown effective in protecting against a number of HPV strains that cause cervical cancer, the vaccine is “not a substitute for screening,” Luciani said. Cervical cancer screening will still be required to protect women who are already infected by HPV strains targeted by Gardasil and to protect against HPV strains the vaccine is not effective against, she said.

For more information, visit www.paho.org.