Early detection concomitant with appropriate treatment intervention for
pre-invasive cervical cancer has proved effective in the ‘war on
cervical cancer’ in the developed world. Unfortunately, these advances
have not been mirrored in the developing world, where incidence and
mortality rates are currently approximately 90% of the world’s burden.
Due to economic, infrastructure and skilled personnel constraints, the
impact of cytology screening as a method for early detection and
reducing mortality rates from cervical cancer is lower. Typically, women
present with advanced disease that is difficult to treat because of de
novo and pharmacokinetic resistance. Whilst the HPV vaccine is a welcome
development in the fight against cervical cancer, for women who are
outside the target age of vaccination, or indeed do not have access to
vaccination, screening remains the only form of protection. Current
excisional treatments available for cervical dysplasia are effective but
have limitations, including increased incidence of obstetric
complications and risk of recurrence. This is a particular issue in
cases of HIV, which is endemic in the regions most affected by cervical
cancer. Therefore, early detection combined with early treatment is an
attractive strategy to reduce the number of women presenting with drug
resistant disease in developing countries where cytology screening and
vaccination services are poorly developed. This review makes the case
for developing a locoregional treatment therapy for cervical dysplasia
which could be incorporated into a cervical cancer screening strategy in
a rural setting within a developing country.