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similar to or better than that of the Pap test. Although the method is quite simple and lower-level health
care workers can learn the skill, adequate training is mandatory.
The newest technology for cervical cancer screening is
HPV DNA testing, and PATH and partners are evaluating
the careHPV Test, a low-cost method appropriate for
developing countries. Easy-to-follow instructions and
color-coded reagents make it possible for lower-level
technicians to perform the test after a short training
period.
Sensitivity of HPV DNA testing on
specimens from vaginal selfsampling
is nearly as high as that
from cervical samples obtained
by health care providers.
Results are encouraging: the sensitivity of the test has been reported at over 90 percent, and a study has
estimated that a woman with a negative test result has a negligible chance of developing precancer over
the subsequent ten years.
Further good news is that the sensitivity of the test on specimens obtained by vaginal self-sampling is
nearly as good as that in cervical samples obtained by health care providers, at 81 percent compared
with 90 percent in a recent clinical study, suggesting that self-sampling could be an important option in
the future.
Dr. Jeronimo emphasized the continuing need for VIA and associated training: the paradigm for
screening with HPV DNA testing is that women who test DNA positive must then have VIA (or some
other method of visualizing the lesions) and treatment with cryotherapy, or if the lesions are more
advanced, they must be referred for higher-level care.
With clinical studies showing promising results, the PATH Screening Technologies to Advance Rapid
Testing—Utility and Program Planning project (START-UP) is now under way in Uganda, India, and
Nicaragua to demonstrate how to organize and monitor HPV DNA testing programs.
In conclusion, cervical cancer screening and treatment is evolving, with molecular tests becoming
available in developing countries. In addition to the technical advantages mentioned above, the
possibility of using vaginal samples self-collected by women holds great promise for increasing the
number of women willing to take advantage of cervical cancer screening.
Report of an African Regional Meeting on Cervical Cancer: September 2010 41