Screen-and-Treat Approaches for Cervical Cancer Prevention in Low-Resource Settings

Abstract

Each year 471 000 cases and 233 000 deaths occur from cervical cancer worldwide, of which 80% occur in less-developed countries that have access to less than 5% of global cancer treatment resources.¹ The lifetime risk of a woman developing cervical cancer in a low-resource setting is approximately 2% to 4%.^2-4 Cytology-based screening programs have markedly reduced the incidence of cervical cancer in developed countries that have the infrastructure to support these programs.⁵ However, screening programs have proven difficult to implement in low-resource settings. There are 2 predominant reasons why cytology-based programs have proven difficult to implement and sustain in low-resource settings. One is the nature of the screening test.⁶ High-quality cytology laboratories are difficult to maintain and there are often substantial delays before the results become available.⁷ Another is the extensive workup that is typically used for women with abnormal cytological results. In developed countries, women with abnormal cytological results are usually referred for colposcopy with biopsy before initiating treatment.⁸ Although this helps ensure that only women with high-grade cervical cancer precursors receive treatment, colposcopy services and histopathologic laboratories often are not available in low-resource settings.