By Susan Cotton, Chair of The Lily Project
Despite the introduction of Pap Testing in the 1960s, regular Pap screening is available to less than 10% of women in Nicaragua. Cervical cancer remains the largest cancer killer of women in Nicaragua, which is burdened with the highest annual rate of death from cervical cancer of any country in the Americas. Cervical cancer in Nicaragua disproportionately affects rural communities where there is very limited access to preventive health care including Pap tests and a high incidence of sexually transmitted disease. Additionally when cancer is discovered, these communities do not have the resources to treat the woman and help manage her pain – contributing to a horrible death and compounding the tragedy of this preventable disease.
Given the lack of success in relying on Pap tests to prevent cervical cancer in low resource countries, alternative evidence-based preventive measures are being developed and promoted. Global health organizations and advocacy groups, including the WHO and PAHO are investing in new screening methods and a simple ‘screen and treat’ approach. During the last decade, a great deal of research has been conducted that proves the efficacy and cost-effectiveness of these newer approaches in slowing the incidence of cervical cancer in developing countries, primarily in Africa and Latin America.
Visual Inspection with Acetic Acid (VIA). This screening test identifies pre-cancerous areas of the cervix by washing with simple distilled vinegar (acetic acid). When swabbed, abnormal lesions become white and can be seen by the naked eye or with low magnification. The advantages of this screening method compared to Pap tests are it is less costly, doesn’t require highly skilled lab technicians and offers an immediate result. One reason the Pap testing method has been ineffective in low-resource countries including Nicaragua, is it often requires multiple visits to complete a full screening given there is a relatively high rate of false positives and need for repeat exams. In Nicaragua, this will often mean women will travel great distances leaving their children at home, creating a lifestyle barrier that is difficult to overcome.
Screen and Treat. A method of combining VIA, with cryotherapy, which freezes and destroys abnormal tissue on the cervix, is a procedure being adopted to combat these issues. A discussion paper presented at the United Nations in 2011 recommends cervical cancer screening using VIA and treatment of precancerous lesions through cryotherapy as a 'best buy' because it a highly cost-effective use of health dollars, costing less than US$ 0.50 per capita to implement in low income countries. The procedure is beautiful in its simplicity: a trained health provider swabs a women’s cervix with vinegar; infected cells, if any, become white; and cryotherapy is performed to freeze and destroy the abnormal tissue.
Leaving it up to a woman to travel to a clinic hours away to get a Pap test, then waiting months to receive her results, then traveling to a hospital even further away if treatment is required, is not a reasonable solution to this unreasonable problem. Instead, The Lily Project combines proactive outreach and sexual health education with this simple, cost-effective screen and treat procedure to bring health to women in the communities we serve.
The Lily Project, a women’s health NGO in Nicaragua, improves the lives of women and girls through a women-centered model of care and development. Lily’s mobile health clinics care for the whole woman - providing cervical cancer screening and treatment, reproductive and sexual health education, trauma counseling, and community building. Learn more: thelilyproject.org