TY - JOUR T1 - Is It Time to Move Beyond Visual Inspection With Acetic Acid for Cervical Cancer Screening? JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 242 LP - 246 DO - 10.9745/GHSP-D-18-00206 VL - 6 IS - 2 AU - Shannon L. Silkensen AU - Mark Schiffman AU - Vikrant Sahasrabuddhe AU - John S. Flanigan Y1 - 2018/06/27 UR - http://www.ghspjournal.org/content/6/2/242.abstract N2 - Newly emerging low-cost molecular assays and improved visual tests for cervical cancer screening call into question the role of visual inspection with acetic acid (VIA). VIA-based screening continues to offer a low-cost, single-visit approach for screening. However, VIA is highly rater-dependent and has problematic accuracy. RNA, DNA, and protein tests are now available. They offer greater accuracy and the option for self-sampling, but the testing kits are expensive. As these new options continue to improve, the time to move beyond VIA is fast approaching.See related article by Ouedraogo.In this issue of GHSP, Yacouba Ouedraogo and colleagues describe successes and lessons from a limited scaling up of a cervical cancer prevention program in Burkina Faso based on visual inspection with acetic acid (VIA).1 Is now the time to ramp up cervical cancer screening and, if so, should VIA be included? Ouedraogo et al.'s commitment to measuring the impact of the program provides data to examine this question.Cervical cancer is highly prevalent in sub-Saharan Africa; the disease can strike women young, prompting the decision to start screening at age 25 in Burkina Faso. The median age for associated mortality is in the early 50s, often during women's most productive years when family and community depend on them.Cervical cancer mortality is stubbornly persistent in many low- and middle-income countries. The striking progress seen in decreasing maternal-fetal mortality and infectious disease deaths is not seen for this disease. In fact, the Global Burden of Disease models show that we are at a crossover point with cervical cancer mortality exceeding maternal deaths during childbirth (Figure 1).FIGURE 1 Deaths From Childbirth and Cervical Cancer, 2000–2015Source: IHME (2016).2We are now at a crossover point with cervical cancer mortality exceeding maternal deaths during childbirth.Human papillomavirus (HPV) is a … ER -