Every year, more than 300,000 women worldwide die from cervical cancer. Over 85% of those deaths occur in developing nations. In fact, cervical cancer is the most common cause of cancer-related deaths for women in low and middle income countries. Perhaps the most unsettling factor: Human papillomavirus (HPV), the group of viruses that cause cervical infection, is very easily treated and further, cervical cancer itself is also easily prevented.

Most sexual active adults, both males and females, will be infected with HPV at some point in their lives. As high as 90% of HPV infections will clear without medical intervention, but the small proportion that don’t can progress to cancer. While HPV infection is accountable for almost every case of cervical cancer, simple exams have decreased the incidence of invasive cancerous cells dramatically in the world’s developed nations within the last 60 years. In the US, most women are tested for cervical cellular abnormalities with yearly Papanicolaou (Pap) smears (though my Dad tells me now it’s only necessary every 3rd year) and more recently with HPV testing. And now, in developed nations, the younger generations fortunately can prevent against the most virulent strains of HPV with the introduction of the Gardasil vaccine.   

But there is also a simpler alternative exam, known as VIA (Visual Inspection with Acetic Acid), that does an equally effective job (and most importantly in developing nations, is less resource intensive) in diagnosing precancerous cervical lesions. And, as it turns out, during our week with the Amazon Promise Foundation in Iquitos, Peru, I became VERY familiar with this exam. Put simply, VIA is an intravaginal exam, performed with a speculum, a large Qtip, some cotton swabs, and white vinegar. The application of diluted vinegar (5% acetic acid ) to the cervix with the extra large Q-tip exposes abnormal tissue by turning it white, and a magnified picture taken with our Gynocular™ Iphone attachment allows an immediate negative/positive diagnosis.

This exam’s benefits are numerous: the supplies are easily acquired and cheap, the exam can be performed by an untrained non-professional (yes, unfortunately this is my current title) in T-8 minutes (I kept timing myself and trying to beat my own record by improving our system), and thanks to today’s technology, the picture taken with the colposcope could most likely be diagnosed without a doctor present on-site. We are conducting a study to see if the picture we took with the colposcope could be evaluated via e-mail, making access to VIA exams for women in developing nations both less expensive, more widespread and more easily performed.

Between two exam rooms, our weeklong campaign throughout the city, and plenty of advertising with our megaphone, our family worked together to screen more than 160 women for cervical cancer. About 18% of our patients had a positive diagnosis, consistent with the worldwide average for developing countries. Astonishingly, 19/20 of our positively diagnosed patients with mostly CIN I-II pre-cancerous lesions, returned to our clinic for cryotherapy treatment. Our two most severe patients, with borderline cancerous lesions, met us at a lab where biopsies were arranged and performed to plan for further treatment methods.

I cannot thank the Amazon Promise foundation enough for its accommodation and the important charity work they do, or our coordinator Rosa enough for her help advertising our examinations, communicating its importance to our patients, scheduling our daily clinic locations in different areas of Iquitos, and ensuring that the positively diagnosed patients had information and access to our treatment options, free of cost. Lastly, I can’t thank the patients enough for trusting the work that we did, and for understanding that cervical cancer screening prevention can potentially save their lives; put simply, screening to prevent cancer is both safer and cheaper than its alternative- treating cervical cancer once it has progressed.

-Lena

PS: thank you Dad for teaching me how to #savethecervix, I learned so much!