Papanicolaou Screening in Developing Countries: An Idea Whose Time Has Come

Abstract

Cervical cancer is the leading cause of cancer-related death among women in developing countries. Although progress is optional in all settings, Papanicolaou screening is feasible anywhere that cervical screening is appropriate and should be implemented without further delay in high-risk communities with access to curative treatment services. Successful prophylactic cervical cancer vaccines, prospects for which remain uncertain, will not eliminate requirements for cervical screening. The feasibility of human papillomavirus test analysis has not been demonstrated in low-resource developing country settings. Because past failures of cervical screening in developing countries are attributable to failures in programmatic quality rather than to technological limitations of the screening test, a shift in paradigmatic focus from technology toward quality is mandatory. Because visual screening techniques coupled with immediate ablative treatment are rendered obsolete by an embedded quality-control paradox, a moratorium should be placed on all such programs. Considerable opportunity costs, borne by the underserved, are associated with prioritizing research of novel interventions in developing countries when satisfactory interventions already exist.

Conventional Pap Smear and Liquid-Based Cytology as Screening Tools in Low-Resource Settings in Latin America

“…21 Other potential screening tools are visual inspection (VIA or VILI) 22 and colposcopy. 23,24 The limitations of Pap test sensitivity and high number of equivocal diagnoses opened an important window for the HPV HCII test as an adjunct method of improving the detection of cervical lesions. 25,26 Prompted by these recent developments, we designed a major multicenter trial testing a set of 8 diagnostic tests as optional screening tools in low-resource settings in 2 Latin American countries.…”

Uterine Cervical Smear Patterns In Females Attending A Teaching Hospital In Rural Eastern Uttar Pradesh, INDIA.

“…A raised prevalence of epithelial cell abnormality reflects the lack of awareness among people about cervical cancer screening programme. [8,13]Seeing to this it becomes the duty of every governmental and non-governmental agency to sensitize the mass regarding this preventable cancer of cervix.…”

“…This may be attributed to the absence of an efficient cervical cancer screening system in the developing countries. [8,13] Cervical smears have become a valuable tool in screening for cervical lesions even at rural peripheral centres because of its easy availability, cost effectiveness, sensitivity, specificity and reliability.…”

Screening for Cervical Cancer in Low-Resource Settings in 2011

“…84,86 What is really striking is the amount of money that has been spent and the number of publications that have been produced, sometimes with conflicting results, 58,69 to promote DVI, which has lead to a bias against the Pap test. If even part of that effort and money had been applied to enhancing existing cytology programs in low-resource countries, how many more women would have received screening by this date?…”

“…Although the major pathology organizations, especially the College of American Pathologists and the American Society of Cytopathology, have generously supported individual cervical cytology screening programs in underserved countries, it is not too late to mount a concerted, unified effort by pathology professional organizations to promote cervical cytology screening on a larger scale throughout the world as enthusiastically as other organizations like Alliance for Cervical Cancer Prevention and Cervical Cancer Action promote DVI techniques. 86 Finally, the problem of cervical cancer is dwarfed by other urgent needs in poor countries, such as control of infectious diseases, enhancement of health care delivery systems, and a slowing of the health care worker drain from poor to more-affluent nations. 87,88 …”