Expanding paradigms for cervical cancer screening: The impact of the Alliance for Cervical Cancer Prevention (2013)

In 1999, visual inspection methods of cervical cancer screening had garnered some interest, but were not yet considered “proven” technologies. In the nine years following inauguration of the Alliance for Cervical Cancer Prevention (ACCP), its partners conducted studies comparing a number of screening techniques including cytology, visual inspection methods using acetic acid (VIA) or Lugol’s iodine (VILI), and a state-of-the-art human papillomavirus (HPV) DNA test in over 20 low-resource settings around the world. The studies also investigated the feasibility of combining screening and cryotherapy treatment into a screen-and-treat approach more convenient for patients and providers, and which significantly reduces dropout and improves compliance. ACCP’s contribution to the body of evidence is significant—of 100 peer-reviewed articles on visual inspection published between 2000 and 2008, 49% included ACCP contributions. Screening and treatment programs that began as ACCP study sites now are scaling up in many countries worldwide and international policy guidelines commonly refer to ACCP findings and quote ACCP recommendations. Key points • Prior to ACCP, alternatives to cytology (visual inspection and HPV DNA testing) were considered unproven. New screening paradigms using these methods are now being featured in training courses from the World Health Organization and many other groups. • Since 2000, the evidence base on these alternatives has increased exponentially, with much of the data generated through the ACCP grant. • Visual inspection methods now are viewed not only as appropriate for primary screening, but also for treatment triage for women screened with new HPV DNA tests. As more global health leaders and international organizations urge health care providers to examine the evidence on alternatives to cytology, and as more providers learn about these alternatives, ACCP expects that new screening paradigms will be adopted, and adapted, for local situations. Because the technologies were developed with low-resource settings in mind, it is likely that cervical screening finally can find success in the places where it is most needed. Now, in 2013, acknowledging the rapid uptake of VIA and cryotherapy in much of the developing world, the partners have agreed that by and large the ACCP research agenda has been accomplished and have decided to disband the partnership. That said, many of the partners continue working on cervical cancer prevention, often focusing their energy on providing technical assistance for screening and treatment program inauguration or expansion, and collaborating with partners in other coalitions.