Cervical cancer, geographical inequalities, prevention and barriers in resource depleted countries (Review)

Abstract

Cervical cancer (CC) remains a current global issue, with >90% of cervical cancer cases being attributed to human papilloma virus (HPV). The highest burden of cervical cancer is reported in resource-depleted geographical areas with a high incidence of HPV infection. Recent developments in primary prevention include vaccinations against specific strains of HPV and the psychoeducation of the public. Yet, despite the availability of vaccinations, there is high incidence of both HPV and cervical cancer in developing countries, which is attributed to a multitude of barriers including inaccessibility to expensive vaccines. With regards to secondary prevention, progress is actively being made to develop more effective methods of screening and to specifically address the needs of low-income countries. In the past few years, more novel screening methods, such as self-assessment kits, immunohistochemistry and methylation marker analysis, have been developed. Barriers to screening in resource-depleted countries include limited financial resources and infrastructure to develop screening programmes, a lack of screening programmes that are accessible to populations, inadequate training of healthcare teams and stigma related to medical examinations performed as part of screening. Developing primary and secondary prevention programs, as well as addressing the barriers involved in countries with low socioeconomic levels, can drastically reduce morbidity and mortality rates associated with cervical cancer, thus reducing the burden associated with this gynaecological malignancy. Contents1. Introduction 2. Epidemiology and geographical inequalities in the burden of CC 3. Primary prevention and barriers faced by developing countries 4. Vaccinations 5. Psychoeducation 6. Secondary prevention and challenges faced by developing countries 7. Recent developments in screening methods 8. Barriers to screening in low resource countries and strategies for improvement 9. Conclusion

Cervical Cancer Prophylaxis—State-of-the-Art and Perspectives

“…The number of false negative results ranges from 25% to 50% [ 31 ]. For LBC, the sensitivity is 61–66% with a specificity of 82–90% [ 32 , 33 ]. The sensitivity of Pap cytology is low and should be supplemented with other diagnostic methods [ 34 , 35 ].…”

Human papillomavirus (HPV) vaccination: a call for action in Italy

“…In particular, HPV 16 and 18 are associated with more than 70% of cervical cancer cases 2 4. Worldwide, cervical cancer is the fourth most frequent malignancy in women, with an estimated 604 000 new cases in 2020 5 6. In this review we provide a narrative review of the current evidence regarding the safety and effectiveness of vaccines against HPV.…”

The significance of nonsurgical therapies for cervical infection of high‐risk human papilloma virus: A systematic review and meta‐analysis

“…World Health Organization estimated that the prevalence of HPV infection was between 9% and 13% of the world population, only in the United States, there were more than 6.2 million positive women every year 4–6 . Despite the prophylactic vaccines could effectively avoid new infection, they were not effective in eradicating existing infections 7 ; meanwhile, these vaccines merely induced specific immunity to certain HPV types, and the efficacy of cross‐immunity for non‐covering type was weak 8 ; furthermore, their immunization longevity needed to be evaluated in the long term; finally, the inaccessibility to vaccines in resource‐poor regions had already been proven to be responsible for a substantial worldwide burden 9 . Most hr‐HPV infections were spontaneously cleared within 6–18 months without any interventions, 10 they were advised to keep in long‐term follow‐up.…”