Burden of cervical cancer and role of screening in India

Abstract

Background:Cervical cancer is a major cause of cancer mortality in women and more than a quarter of its global burden is contributed by developing countries. In India, in spite of alarmingly high figures, there is no nationwide government-sponsored screening program. This study was conducted to assess the burden of cervical cancer in India and review the performance characteristics of available cervical cancer screening tools, so as to provide evidence-based recommendations for application of most practically suited screening test to be used in resource-poor field settings.Materials and Methods:MEDLINE and Web of Science electronic database were searched from January 1990 to December 2015, using the keywords such as “cervical cancer”, “screening”, “early detection”, “cervical cytology” and “visual inspection”, and their corresponding MeSH terms in combination with Boolean operators “OR, AND.” Two authors independently selected studies that are published in English and conducted in India. A total of 11 studies were found to be relevant and eligible to be included in the present study.Results:In India, cervical cancer contributes to approximately 6–29% of all cancers in women. The age-adjusted incidence rate of cervical cancer varies widely among registries; highest is 23.07/100,000 in Mizoram state and the lowest is 4.91/100,000 in Dibrugarh district. The pooled estimates of sensitivity and specificity of visual inspection with acetic acid (VIA), magnified VIA, visual inspection with Lugol's iodine (VILI), cytology (Pap smear), and human papillomavirus DNA were found to be 67.65% and 84.32%, 65.36% and 85.76%, 78.27% and 87.10%, 62.11% and 93.51%, and 77.81% and 91.54%, respectively.Conclusions:In developing countries because of lack of necessary infrastructure and quality control, high-quality cytology screening may not be feasible for wide-scale implementation. Hence, cervical cancer screening program based on visual screening test such as VIA/VILI should be adopted as an integral part of primary health-care setup in resource-poor countries like India.

A Study of Pap Smears in HIV-Positive and HIV-Negative Women from a Tertiary Care Center in South India

“…Worldwide, 15% of all cancers in women are cervical cancers, while in Southeast Asia cervical carcinoma accounts for 20–30% of all cancers in women [4]. India alone accounts for one-quarter of the global burden [10]. …”

Screening and management of preinvasive lesions of the cervix: Good clinical practice recommendations from the Federation of Obstetrics and Gynaecologic Societies of India (FOGSI)

“…To be most cost‐effective, the age of starting and stopping screening is determined by the age‐specific cancer burden. In India, the burden of cervical cancer under the age of 30 years is very low and it is negligible under the age of 25 years . According to Globocan 2018, the age standardized incidence rate below 29 years is 0.46/100 000 women and below 24 years, is as low as 0.06 per 100 000 women .…”

“…VIA is a promising tool for screening in low‐resource settings because it is economical, with minimal loss to follow up . The pooled sensitivity and specificity of VIA to detect CIN2+ ranged from 16% to 82.6%, and 82.1% to 96.8%, respectively . VIA when compared with cytology has higher sensitivity (90% vs 50%) but lower specificity (37% vs 93.5%) thus raising the burden of false positive cases .…”

An Analysis of Pap and Pap - HPV Testing for Cervical Cancer Screening in Tertiary Care Center a Retrospective Study in a Teaching Instituition of Govt. Madurai Medical College Hospital, Madurai, Tamil Nadu

“…According to GLOBOCON 2018, cervical cancer ranks fourth among women in both newly detected cases and cancer deaths worldwide. In developing countries, Cancer cervix is a major cause for cancer mortality in women [1].The incidence of cervical cancer cases differs in developing and developed countries. The burden of cervical cancer is still high in developing countries like India.…”