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 over the last 30 years, "generally they have achieved very limited success in controlling cervical cancer in those regions", the researchers say.
"Although some cytological screening is being carried out, there are no organized programmes and testing is often of poor quality and carried out inadequately and inefficiently among the population. As a result, there has been a very 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 industrialized 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 out 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 organized 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 screen frequently a wide age range of women, the authors say.
Low-income countries should consider planned investments to improve 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, middle-income countries with inefficient programmes should reorganize them, the study recommends. Many of these programmes work with the "unrealistic notion" of very frequently repeated screening tests - once a year - that target a wide age range (e.g. 20-65 years) of women.
"It is more realistic and effective to target high-risk women (e.g. 35-49 years or 30-50 years) with a good quality and highly sensitive test once or twice in their lifetime, " the study says. Even a once-in-a-lifetime test can yield a reduction of 25-30% in incidence.
The authors are Dr Rengaswamy Sankaranarayanan, scientist at the International Agency for Research on Cancer, in Lyon, France; Mr Atul Madhukar Budukh, manager of the cervical cancer prevention programme at the Nargis Dutt Memorial Cancer Hospital, in Barshi, Maharashtra, India; and Dr Rajamanickam Rajkumar, medical officer at the Christian Fellowship Community Health Centre, Ambillikai, Tamil Nadu, India.
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