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LETTER |
Jacqueline Sherris and John W. Sellors are with PATH, Seattle, Wash. Thomas C. Wright, Jr is with the Department of Pathology, Columbia University, New York, NY. Lynette Denny is with the Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa. Rengaswamy Sankaranarayanan is with the International Agency for Research on Cancer Screening Group, Lyon, France. Amy E. Pollack is with the Mailman School of Public Health, Columbia University, New York. Harshad Sanghvi is with JHPIEGO, Baltimore, Md.
Correspondence: Requests for reprints should be sent to Jacqueline Sherris, PhD, PATH, 1455 Leary Way NW, Seattle, WA 98117 (e-mail: sherries{at}path.org).
The recently published article by Suba et al.1 advocates for expanded access to Papanicolaou testing worldwide and for analysis of obstacles to effective screening programs. We are pleased to see discussion of this important topic in the Journal.
Suba et al. criticized the work of the Alliance for Cervical Cancer Prevention (ACCP), an alliance of 5 organizations with a goal of reducing cervical cancer deaths among the world’s poorest women. The article repeats previous criticisms the authors have made,2 including about the safety of visual screening approaches, the ethics of several ACCP studies, the assertion that ACCP leaders are "loath to recommend"1(p50) cytology, and the theoretical underpinnings of ACCP cost analyses.
We strongly disagree with the authors’ comments about our work and have responded in detail to these criticisms previously. We refer Journal readers to our most recent response to Suba et al.3 and to the voluminous evidence describing our work, a small portion of which is cited here.4–10 The comprehensive work of the ACCP can be reviewed online (http://www.alliance-cxca.org); we invite readers to visit the site and make their own determinations regarding ACCP’s ethical, clinical, scientific, and public health value.
Another recurring criticism that Suba et al. make about ACCP’s work is that it is influenced by private-sector interests. We would like to take this opportunity to set the record straight. The ACCP has never received funding from any commercial entity. An erroneous statement about an ACCP link with Digene Corporation in a 2004 editorial has been corrected.11 Suba et al. may be misinterpreting PATH’s separate START project (http://www.path.org/projects/start_project.php), which is working to develop simple, rapid, and affordable biochemical screening tests (including a simpler human papilloma-virus test) in partnership with 2 private-sector companies. The START project is funded by the Bill & Melinda Gates Foundation and the National Institutes of Health; PATH receives no funding from commercial partners for START work.
It is regrettable that Suba et al. discourage new approaches to cervical cancer prevention, often with arguments based on uninformed or inaccurate information. We believe that there are multiple strategies to prevent cervical cancer, including well-run cytology-based programs, human papilloma-virus DNA testing–based programs, "screen-and-treat" programs, and human papilloma-virus vaccine introduction. Women in developing countries clearly will benefit from the new policies, programs, and pilot efforts related to these approaches.
References
1. Suba EJ, Murphy SK, Donnelly AD, Furia LM, Huynh ML, Raab SS. Systems analysis of real-world obstacles to successful cervical cancer prevention in developing countries. Am J Public Health. 2006;96: 480–487.
2. Suba EJ, Donnelly AD, Furia LM, Huynh ML, Raab SS. Coming to terms with Vietnam: the Viet/American cervical cancer prevention project. Diagn Cytopathol. 2005;33(5):344–351.[CrossRef][Web of Science][Medline]
3. Wright TC, Blumenthal P, Bradley J, et al. ACCP letter to the editor. Diagn Cytopathol. In press.
4. Sankaranarayanan R, Nene BM, Dinshaw KA, et al. A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India. Int J Cancer. 2005;116:617–623.[CrossRef][Web of Science][Medline]
5. Goldie SJ, Gaffikin L, Goldhaber-Fiebert JD, et al. Cost-effectiveness of cervical-cancer screening in five developing countries. N Engl J Med. 2005;353: 2158–2168.
6. Royal Thai College of Obstetricians and Gynecologists/JHPIEGO Corporation, Cervical Cancer Prevention Group. Safety, acceptability, and feasibility of a single-visit approach to cervical cancer prevention in rural Thailand: a demonstration project [published correction appears in Lancet. 2003;361(9373):1994]. Lancet. 2003;361(9360):814–820.[CrossRef][Web of Science][Medline]
7. Denny L, Kuhn L, De Souza M, Pollack AE, Dupree W, Wright TC Jr. Screen-and-treat approaches for cervical cancer prevention in low-resource settings: a randomized controlled trial. JAMA. 2005;294: 2173–2181.
8. Sankaranarayanan R, Gaffikin L, Jacob M, Sellors J, Robles S. A critical assessment of screening methods for cervical neoplasia. Int J Gynaecol Obstet. 2005; 89(suppl 2):S4–S12.[CrossRef][Medline]
9. Jacob M, Broekhuizen FF, Castro W, Sellors J. Experience using cryotherapy for treatment of cervical precancerous lesions in low-resource settings. Int J Gynaecol Obstet. 2005;89(suppl 2):S13–S20.[CrossRef][Medline]
10. Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers. Seattle, Wash: Alliance for Cervical Cancer Prevention; 2004.
11. Robles SC, Periago MR. Guanacaste, Costa Rica: a landmark for cervical cancer prevention [published correction appears in Rev Panam Salud Publica. 2006; 19(3):162]. Rev Panam Salud Publica. 2004;15(2): 73–74.[Web of Science][Medline]
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