Lessons learned from successful Papanicolaou cytology cervical cancer prevention in the socialist republic of Vietnam

Abstract

In 1996, we documented that the burden of cervical cancer in Vietnam was associated with troop movements during the Vietnam War. Subsequently, establishment of Papanicolaou screening in southern Vietnam was associated with reductions in cervical cancer incidence from 29.2/100,000 in 1998 to 16/100,000 in 2003. This is one of the first English-language reports of a real-world cervical cancer prevention effort associated with a decisive impact on health outcomes in a contemporary developing country. Lessons learned: if our ideological commitment is to improve health outcomes as rapidly as possible among as many people as possible, then Papanicolaou screening (with or without HPV or visual screening) must be implemented without further delay in any setting where cervical screening is appropriate but unavailable; consideration must be given to HPV vaccination after, rather than before, full coverage of target demographic groups by screening services has been achieved and/or the possibility has been excluded that HPV vaccination may be ineffective for cancer prevention. Competing ideological commitments engender imprudent yet commercially useful alternative strategies prone to decelerate global reductions in mortality by suppressing the more-rapid uptake of less-expensive open-source technology in favor of the less-rapid uptake of more-expensive proprietary technologies with uncertain real-world advantages and unfavorable real-world operational limitations. Global cervical cancer prevention efforts will become more effective if global health leaders, including the Bill & Melinda Gates Foundation, embrace an ideological commitment to improving health outcomes as rapidly as possible among as many people as possible and assimilate the policy implications of that commitment.

Validation of Cervical Cancer Screening Methods in HIV Positive Women from Johannesburg South Africa

“…Cytology based screening (via the Pap smear) is the only screening method that has been shown to reduce mortality in many places in the world including middle and lower resource countries such a Colombia, Chile and Vietnam [14]–[16]. The performance of Pap smear screening for CIN 2+ among women in general population-based studies internationally has ranges for both sensitivity (40–86%) and specificity (88–99%) [17]–[19].…”

Papanicolaou (pap) test in staff members in a tertiary health care centre in south india

“…7 In fact successful implementation of Pap test screening in southern Vietnam, which recorded reductions in cervical cancer incidence from 29.2 per 100,000 in 1998 to 16 per 100,000 in 2003 reiterates t hese view. 8 A st udy from neighbouring Bangladesh 5 showed a higher prevalence (8.2%) of epithelial cell abnormality in the Pap smear in contrast to other studies. 5,9,10 The authors of this study attributed this high prevalence to the fact that the patients included in the study visited the tertiary care hospital for specific gynaecological complaints.…”

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