Rationale for Screening | Treatment | Managing Precancerous Cervical Disease | Links to Other Reproductive Health Services | References | Printer-Friendly Version (104k, Adobe Acrobat)

Cervical cancer continues to be an important women’s health problem throughout the world. Each year nearly 400,000 new cases occur—almost 80% in women living in developing countries—and at least 200,000 die of the disease (Pisani 1998, Sherris et al 1998). Worldwide, cervical cancer is the second most common cancer in women. As shown in Figure 1, while nearly 300,000 new cases are identified annually in developing countries, less than 100,000 occur in the United States and Europe. Although implementation of Pap smear screening programs has reduced the incidence of cervical cancer in industrialized countries, such programs have been difficult to establish and maintain in the developing world.

Figure 1. Estimated Number of New Cervical Cancer Cases per Year, 1990 (Based on Reports)

Source: Pisani 1998. 

An important reason for the higher cervical cancer rates in developing countries is the lack of effective screening programs designed to identify precancerous lesions and treat them before they progress to invasive cancer. It is estimated that only about 5% of women in developing countries have been screened within the past 5 years, compared with some 70% in the United States and some countries in northern Europe (WHO 1986). The lack of access to screening, coupled with the increasing prevalence of human papillomavirus (HPV), which is the primary cause of cervical cancer, further contributes to the higher rates seen in many countries (Walboomers 1999).

The data presented in Figure 2 show that cervical cancer is a disease of the mid to late reproductive years; however, its precursor, dysplasia or cervical intraepithelial neoplasia (CIN), occurs in much younger women. Also of concern are findings from several studies suggesting that human immunodeficiency virus (HIV)-positive women are at increased risk for cervical cancer (Judson 1992, Womak et al 2000). Moreover, because HIV rates are increasing in many of the countries with already high cervical cancer rates, it is very likely that deaths due to this disease will continue to increase.

Figure 2. Age Distribution of Cervical Cancer Cases (1989) 

Source: Sanghvi 1994. 

The levels of mortality associated with cervical cancer are the most convincing indicators of its impact on women, their families and their communities. Mortality data sometimes are used as substitutes for incidence data in countries with little screening or treatment activity because cervical cancer is nearly always fatal if not detected and treated in its precancerous stage. A 1986 analysis suggested that by the year 2000, worldwide about 550,000 person-years of life would be lost from cervical cancer each year if effective screening programs are not initiated (Sherris 1998). Because this type of cancer develops slowly and has a detectable precursor, dysplasia or CIN, that can be successfully treated, the situation is particularly unfortunate as all deaths from cervical cancer could be avoided.

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