Screening for cervical cancer revisited: understanding implementation research
In the editorial “Ethics of ‘standard care’ in randomised controlled trials of screening for cervical cancer”, Sandhya Srinivasan argues persuasively that a series of placebo-controlled trials on screening for cervical cancer in India were unethical. The purported aim of the trials was to study the method that uses visual inspection of the cervix following staining with acetic acid (VIA), to determine the efficacy of the method in a low-resource setting. Srinivasan notes: “The researchers in these trials have argued that only a ‘no care’ control arm can give definitive results and this information is essential to guide policies and programmes….VIA has been researched at least since the early 1990s. VIA is an affordable screening test, and there is evidence suggesting that it works about as well as the Pap smear”).
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