Uganda Embraces Low-Tech Test for Cervical Cancer

Monday, April 20, 2009

In Uganda, a fast, cheap diagnostic test based on vinegar is invigorating the battle against cervical cancer. Health activists are raising money to put it in a mobile clinic and health officials are eyeing a national rollout. First of two stories.

KAMPALA, Uganda (WOMENSENEWS)--Claire Judith Achieng remembers how long it used to take to receive the results of a Pap smear, which can help detect cervical cancer.

Women such as herself, who live outside the capital of Kampala in eastern Uganda, would need to travel significant distances to a few referral hospitals for the screening test. From there, all Pap smears were transported to the capital for analysis at Mulago Hospital, after which the results were sent back to the original hospital or clinic.

The process could take six months.

In Uganda, cervical cancer is the leading cause of cancer deaths among women, although the cancer typically takes between 10 and 20 years to reach an advanced state and is very treatable if it's caught early.

The disease's slow development should give women ample time to have the condition's telltale lesions detected and treated. However, the vast majority of women in Uganda have never had a Pap smear. Other factors, like early marriage and HIV, make women more susceptible.

In 2006 a group of doctors and public health activists began searching for ways to boost screenings. They belonged to the Uganda Women's Health Initiative, collaboration between Makerere University, a public university based in Kampala, and the University College London's Institute for Women's Health.

Screenings in Small Centers

They started a pilot project in Kampala to demonstrate that cervical cancer screening was possible in small health centers.

As part of that project, two clinics began screening women with a fast, innovative test that used acetic acid--or vinegar--as the primary active ingredient.

The test, called visual inspection with acetic acid, or "VIA," doesn't require a pathologist, refrigeration of samples or a microscope.

A nurse, midwife, or gynecologist swipes a patient's cervix with acetic acid and then inspects the tissue visually. If the cervix has lesions, the tissue turns white.

Currently, public clinics and hospitals continue to screen women using both techniques, but many gynecologists have begun using a positive visual test as a basis to start treatment on the spot. The treatment, called cryotherapy, freezes the lesions and treats the disease in its early stages, before the cancer becomes advanced. It does this by destroying abnormal cells in the cervix that may lead to cancer. The swift move from diagnosis to treatment saves patients' time and transportation costs.

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