Screening for cervical cancer in developing countries

Abstract

Cervical cancer is the most common malignancy amongst females in developing countries, mainly due to a lack of precursor screening. This absence of screening is the result of inherent disadvantages of the Pap smear: high cost, low sensitivity, the need for a laboratory with high human expertise and a complex screening program logistic system. The prerequisites for screening in a developing country include a screening method that is affordable, which can be effectively applied once in a lifetime at the age of 30-35 years, provide an immediate result and thereby allowing for on-site treatment of positive cases. None of the current screening methods comply with these prerequisites. More research is necessary into different combinations of tests, which improve sensitivity. On-site human papillomavirus (HPV) identification, alone or in combination with other tests, is promising. Another promising development is immunization against HPV infection, either as a preventative measure or for stimulating immunity in infected women.

Visual inspection with acetic acid for cervical cancer screening in a tertiary health care centre

“…9 However, its current price and technology requirements make this option unrealistic for poor areas. 10 until a low-cost, same-day HPV test and realistic strategies are developed. 11 VIA has arisen as a promising alternative for developing countries because it is inexpensive and fast and requires a low level of training and no special equipment.…”

Use of mammography and Pap smear in Estonia, a country without organized cancer screening

“…If a women can be screened only once for cervical cancer, the best age is 35-45 years (WHO 2006). Yet, none of the current screening methods can be effectively applied once in a lifetime (Cronje 2004 Having mammography according to recommendations was also related to ethnicity and low health self-assessment. Many publications describing breast or cervical cancer screening, have noted that non-attendees are characterized by low income, unemployment, lack of health insurance, place of residence outside the city, belonging to ethnic minorities or being immigrant; age and education have a diverse effect (Nelson et al 2003;Schootman et al 2003;Coughlin et al 2004;Hewitt et al 2004;Meissner et al 2004;Peek et al 2004;Zackrisson et al 2004;Barrett & Leggs 2005); utilization rates for screening programs were similar in all social classes (Röckl-Wiedmann et al 2002).…”

Cervical cancer: the sub-Saharan African perspective

“…55 The default rate among those with cytological abnormalities reaches 60-80% due to the absence of effective mechanisms for recall of women with abnormal smears. 15 The effectiveness of direct visual inspection (visual inspection with acetic acid and visual inspection with Lugol's iodine) as a form of population-based screening is currently being studied in some ongoing projects across the RI Anorlu / Reproductive Health Matters 2008;16(32): [41][42][43][44][45][46][47][48][49] continent, mainly sponsored by international agencies. 6,24 Results from these studies are quite promising and support its use as an alternative to cervical cytology.…”