Cervical Cancer Screening is Failing to Control Disease in Many Developing Countries

Many developing countries clearly need to strengthen their capacity to diagnose and treat early forms of cervical cancer, according to researchers writing in the latest issue of the Bulletin of the World Health Organization. While some developing countries in Latin America and Asia have introduced screening during the past 30 years, generally they have achieved very limited success in controlling cervical cancer in those regions.

Although some cytological screening is being performed, there are no organised programmes and testing is often of poor quality and inadequately and inefficiently performed among the population. As a result, there has been a limited impact on the incidence of cervical cancer, despite large numbers of cytological smears taken in some countries.

Cervical cancer incidence and mortality have fallen substantially in recent years in the industrialised world, arguably as the result of efficient screening programmes involving a cervical smear test, which can detect precursors and early forms of cervical cancer. But at least 8 of every 10 of the global total of 231,000 deaths a year occur in developing countries, where the disease remains largely uncontrolled.

Screening involves substantial costs and many poor countries cannot afford screening programmes of any sort. According to the study, there are no organised cervical cancer screening programmes in many Latin American countries, any of the high-risk sub-Saharan countries, or in India, which accounts for one-fifth of the global burden of the disease.

Countries with limited health care resources cannot afford to frequently screen a wide age range of women. Low-income countries should consider planned investments to improve their capacity to diagnose and treat cervical cancer precursors and early invasive cancers in their health services before considering even limited screening programmes. On the other hand, the study recommends that middle- income countries with inefficient programmes should reorganise them. Many of these programmes work with the 'unrealistic notion' of frequently repeated screening tests once a year that target women of a wide age range (for example 20-65 years). However, it is more realistic and effective to target high-risk women, for example those aged from 35 to 49 years or 30 to 50 years. with a good quality and highly sensitive test once or twice in their lifetime. Even a once-in-a-lifetime test can yield a reduction of 25 to 30% in incidence of cervical cancer.