Estimating the lost benefits of not implementing a visual inspection with acetic acid screen and treat strategy for cervical cancer prevention in South Africa


South Africa has had a national cervical cancer screening policy (2002) based on the Pap (Papanicolaou) smear for more than 10 years which has not been effective. Cancer of the cervix remains a very common cancer among women in South Africa.
Zambia was able to integrate Visual Inspection with Acetic acid screening for cervical cancer and treatment successfully within its public sector HIV/AIDS treatment program while minimizing the need for additional resources.
The aim of this study was to quantify the impact on cervical cancer high grade pre-cursor lesions, new cases and deaths from cervical cancer had South Africa implemented a nurse driven Visual Inspection with Acetic based screen and treat strategy like Zambia (Botswana and Zimbabwe) did.
Using publicly available published evidence based data a statistical model was developed to estimate the aforementioned outcomes that could have been prevented in South Africa had the country followed Zambia’s strategy.
South Africa could have prevented over five years at least 3 300 high-grade cervical pre-cursor lesions, and assuming one round of Visual Inspection with Acetic screening and treatment, 50 cases of cervical cancer and 40 deaths from cervical cancer.
Had South Africa adopted a pragmatic low cost method to prevent cervical cancer like Zambia (Botswana and Zimbabwe) did, substantial morbidity and mortality from cervical cancer would have been prevented. Important public health lessons for politicians, policy makers and others can be drawn from this missed opportunity.

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