Screen-and-Treat Approaches for Cervical Cancer Prevention in Low-Resource Settings: A Randomized Controlled Trial
Abstract
Context Non-cytology-based screen-and-treat approaches for cervical cancer prevention have been developed for low-resource settings, but few have directly addressed efficacy. Objective To determine the safety and efficacy of 2 screen-and-treat approaches for cervical cancer prevention that were designed to be more resource-appropriate than conventional cytology-based screening programs. Design, setting, and patients Randomized clinical trial of 6555 nonpregnant women, aged 35 to 65 years, recruited through community outreach and conducted between June 2000 and December 2002 at ambulatory women's health clinics in Khayelitsha, South Africa. Interventions All patients were screened using human papillomavirus (HPV) DNA testing and visual inspection with acetic acid (VIA). Women were subsequently randomized to 1 of 3 groups: cryotherapy if she had a positive HPV DNA test result; cryotherapy if she had a positive VIA test result; or to delayed evaluation. Main outcome measures Biopsy-confirmed high-grade cervical cancer precursor lesions and cancer at 6 and 12 months in the HPV DNA and VIA groups compared with the delayed evaluation (control) group; complications after cryotherapy. Results The prevalence of high-grade cervical intraepithelial neoplasia and cancer (CIN 2+) was significantly lower in the 2 screen-and-treat groups at 6 months after randomization than in the delayed evaluation group. At 6 months, CIN 2+ was diagnosed in 0.80% (95% confidence interval [CI], 0.40%-1.20%…
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Cervical cancer is preventable with effective screening and treatment of pre-invasive lesions.
“This is despite the fact that cervical cancer is preventable with effective screening and treatment of pre-invasive lesions [2].”
Trained human resources, functional referral and laboratory facilities, and lack of transport and tracking systems make cytology-based screening strategies unfeasible in most LMICs.
“trained human resources, functional referral and laboratory facilities, and lack of transport and tracking systems make cytology-based screening strategies unfeasible in most LMICs [2].”
Testing for HPV is a simple, low-cost technology that reduces cervical cancer incidence and related mortality when directly coupled with outpatient cryotherapy treatment for women testing HPV positive.
“Testing for HPV is a simple, low-cost technology that has been shown to reduce the cervical cancer incidence and related mortality when directly coupled with outpatient cryotherapy treatment for women testing HPV positive [2, 9, 10].”
Cites
Chapter 10: Cervical Cancer Screening Using Visualization Techniques
Wright, T. C. (2003) · JNCI Monographs · doi:10.1093/oxfordjournals.jncimonographs.a003485 · Cited by 41 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
HPV Screening for Cervical Cancer in Rural India
Sankaranarayanan, R., Nene, B. M., Shastri, S. S., Jayant, K., Muwonge, R., Budukh, A. M., Hingmire, S., Malvi, S. G., Thorat, R., Kothari, A., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0808516 · Cited by 1,278 · see citing works
The IARC Perspective on Cervical Cancer Screening
Bouvard, V., Wentzensen, N., Mackie, A., Berkhof, J., Brotherton, J., Giorgi-Rossi, P., Kupets, R., Smith, R., Arrossi, S., Bendahhou, K., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmsr2030640 · Cited by 357 · see citing works
Denny, L., de Sanjose, S., Mutebi, M., Anderson, B. O., Kim, J., Jeronimo, J., Herrero, R., Yeates, K., Ginsburg, O., & Sankaranarayanan, R. (2017) · The Lancet · doi:10.1016/s0140-6736(16)31795-0 · Cited by 246 · see citing works
Self-citationOketch, S. Y., Kwena, Z., Choi, Y., Adewumi, K., Moghadassi, M., Bukusi, E. A., & Huchko, M. J. (2019) · BMC Women's Health · doi:10.1186/s12905-019-0778-2 · Cited by 77 · see citing works
Jacob, M., Mawar, N., Menezes, L., Kaipilyawar, S., Gandhi, S., Khan, I., Patki, M., Bingham, A., LaMontagne, D. S., Bagul, R., et al. (2010) · The Open Vaccine Journal · doi:10.2174/1875035401003010096 · Cited by 29 · see citing works
- Authors
- Denny, L., Kuhn, L., De Souza, M., Pollack, A. E., Dupree, W., & Wright, T. C.
- Affiliations
- University of Cape Town (ZA)
- EngenderHealth (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2005-11-02
- Volume
- 294
- Issue
- 17
- Pages
- 2173
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2068042986
- Cited by
- 364
- References
- 1
- Citations by year
- 2026: 13 · 2025: 9 · 2024: 12 · 2023: 9 · 2022: 11 · 2021: 20 · 2020: 12 · 2019: 5 · 2018: 11 · 2017: 15 · 2016: 14 · 2015: 20 · 2014: 20 · 2013: 22 · 2012: 17
- FWCI
- 16.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bill and Melinda Gates Foundation
- Cancer Association of South Africa
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Keywords
- cervical cancer prevention, screen-and-treat, HPV testing, visual inspection with acetic acid, cryotherapy, high-grade cervical intraepithelial neoplasia, resource-limited settings, cervical cancer screening, treatment efficacy, treatment safety, lazy evaluation, women's clinic, colposcopy, cervical cancer incidence
- MeSH terms
- Adult, Biopsy, Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Colposcopy, DNA, Viral, Female, Health Resources, Health Services Accessibility, Humans, Mass Screening, Middle Aged, South Africa, Prevalence, Cryotherapy, Acetic Acid, Papillomaviridae, Papillomavirus Infections
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
