Screening for cervical cancer in resource-limited settings
- Lynette Denny, MD, PhD
Lynette Denny, MD, PhD
- Professor Obstetrics and Gynaecology
- University of Cape Town
- Groote Schuur Hospital and Institute of Infectious Diseases and Molecular Medicine
Cervical cancer is the most common malignancy among women in the developing world, and more than 85 percent of worldwide cervical cancer deaths occur in these settings [1,2]. Effective strategies for cervical cancer screening and treatment of cervical intraepithelial neoplasia, a precursor to cancer, have been in place for more than 70 years and, where applied, have dramatically reduced the incidence of and mortality from this disease [3,4].
However, standard strategies such as cervical cytology, human papillomavirus testing, and colposcopy are often not possible in developing settings due to economic and other infrastructure issues. Health care resources and disease burden vary between and within countries, making it difficult to draw general conclusions regarding screening strategies for the entire developing world. Addressing individual countries is beyond the scope of this topic review. Therefore, cervical cancer screening in health care systems in which cytology or colposcopy are not feasible will be reviewed here.
The general approach to and tests used for cervical cancer screening are discussed separately. (See "Screening for cervical cancer" and "Cervical cancer screening tests: Techniques for cervical cytology and human papillomavirus testing" and "Cervical cancer screening tests: Visual inspection methods".)
Cervical cancer comprises 12 percent of all cancers among women worldwide and is the fourth most common cancer after breast, lung, and colon cancer . Over 85 percent of new cases are diagnosed in the developing world, and in these countries, it is the most common cancer in women . The following links provide global rates of cervical cancer in 2012 from the World Health Organization's GLOBOCAN database: incidence and mortality.
BARRIERS TO CERVICAL CANCER SCREENING
Barriers to implementing programs for cervical cancer prevention include competing health care demands and economic, social, and political issues .
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- BARRIERS TO CERVICAL CANCER SCREENING
- APPROACH TO CERVICAL CANCER SCREENING
- General principles
- Screening frequency and patient age
- Challenges to evaluating screening tests
- VISUAL INSPECTION METHODS
- Visual inspection with acetic acid
- - VIA with magnification
- Visual inspection with Lugol's iodine
- HPV TESTING
- Rapid result HPV test
- Increasing HPV test specificity
- Self-collected samples
- COMBINING TWO SCREENING TESTS
- SCREEN AND TREAT PROTOCOLS
- Treatment method
- One-visit protocols
- Two-visit protocols
- SUMMARY AND RECOMMENDATIONS