Cervical cancer in Nepal: Current screening strategies and challenges

Abstract

Nepal has a high burden of cervical cancer primarily due to a limited screening program. Most present with advanced cervical disease. Despite no national cervical cancer control program, Nepal's Ministry of Health and Population has taken many initiatives with various international collaborations in screening, vaccination, and treating pre-invasive and invasive cancer. However, the existing prevention and treatment modalities are dismally inadequate to meet the targets of WHO's cervical cancer eliminative initiative by 2030. We provide an overview of the Ministry of Health and Population, Nepal's efforts to tackle the growing cervical cancer burden in the country. We discuss the challenges and potential solutions that could be practical and augment screening uptakes, such as single-dose vaccination and HPV DNA tests. The screen-and-treat approach on the same day could potentially address treatment delays and follow-up loss after testing positive. Our narrative summary highlights existing and innovative strategies, unmet needs, and collaborations required to achieve elimination across implementation contexts.

Cervical Cancer Screening and HPV Vaccination in Nepal

“…Thus, the first target from 90-70-90 is halted. 2 The National Guideline for Cervical Cancer Screening and Prevention 2010 aimed to screen at least half of women in the age group of 30 to 60 years, which was revised to 70% in 2017. By 2019, only 8.2% of women aged between 30 and 49 years were screened.…”

A questionnaire study on disparity of cervical cancer prevention programs in Asia‐Oceania

“…Cervical cancer was still the leading cancer in women with incidence of 16.4 per 100 000 women and was the second highest in South East Asia. 88 Cytological screening was opportunistic based and the coverage was 2.8% only. The Ministry of Health and Population of Nepal issued 'The national guideline for Cervical Cancer Screening and Prevention (CCSP)' in 2010.…”

Factors associated with uptake of breast and cervical cancer screening among Nepalese women: Evidence from Nepal Demographic and Health Survey 2022

“…Nepal’s national guidelines for cervical cancer screening (2010) recommend screening with visual inspection with acetic acid every 5 years for women in the age range of 30–60 years [ 17 ]. The goal was set to target at least 50% of women aged 30–60 years in 2010 which was later revised to 70% in 2017 [ 17 ].…”

“…Nepal’s national guidelines for cervical cancer screening (2010) recommend screening with visual inspection with acetic acid every 5 years for women in the age range of 30–60 years [ 17 ]. The goal was set to target at least 50% of women aged 30–60 years in 2010 which was later revised to 70% in 2017 [ 17 ]. Though early screening of breast cancer serves as a leading role in reducing the burden of breast cancer mortality, Nepal has no national and regional breast cancer screening program [ 18 ].…”