Cervical cancer prevention – When trying to settle for ‘the best’ can actually result in worse outcomes: half a loaf is better than no bread?

Saturday, April 30, 2022.

I have had discussions along these lines many times with senior medical doctors (many of them specialists and consultants) in Ghana:

Question: Do you use Visual Inspection with Acetic acid (VIA) for cervical precancer screening in your hospital?

Answer: No

Question: Why not?

Answer: VIA is an inferior method.

Question: So what do you use for screening?

Answer: Pap smears.

Question: How much does a pap smear cost in your hospital?

Answer: …. Ghana Cedis.

Question: This is expensive. Many women cannot afford this?

Answer: True.

Question: You can have VIA for these women at a quarter this price and get many women to be screened. Won’t it be better to bring in VIA for the women who cannot afford? You can then reach out to more women?

Answer: No response.

Question: Do you use cryotherapy or thermal coagulation for treatment of cervical precancer in your institution?

Answer: No we don’t.

Question: Do you perform Loop Electrosurgical Excision Procedure (LEEP) for cervical precancer in your institution?

Answer: No.

Question: Nurses and midwives can be trained to perform cryotherapy and thermal coagulation. Why don’t you build capacity in your hospital to treat cervical precancer with cryotherapy and/or thermal coagulation?

Answer: These are inferior treatment methods.

Question: But you don’t have the superior treatment methods.

Answer: No response.

Question: So where do you send women with cervical precancer to?

Answer: I refer them to a tertiary institution.

Question: As far as I know, there are less than 10 centres in Ghana where LEEP can be performed.
This means your patients have to travel long distances?

Answer: No response.

Question: It is possible that the women you refer do not go?

Answer: No response.

Question: So some might have been better off receiving the inferior treatment of cryotherapy and/or thermal coagulation than not receiving any treatment and possibly going on to develop cervical cancer?

Answer: No response.

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