Abstract
Developed countries have reduced incidence and mortality of cervical cancer (CC) through cytology-based screening programs. Though a large number of the world’s population live in Low and Middle Income Countries (LMICs), cytology-based screening programs have been ineffective in them. Visual inspection with acetic acid (VIA) and the human papillomavirus (HPV) test have proven to be effective primary screening methods for CC screening in LMICs. However, the HPV test is too expensive for introduction in the screening program of many LMICs. VIA is therefore accepted as the method of screening in several LMICs, as it needs minimum infrastructure support and results are available immediately, so additional investigations/management can be carried out during the same visit.
In LMICs screening should be performed in women between 30 and 49 years and repeated every 5 years. In low-resource settings, a fewer-visit approach should be adopted, and screen-positive women should be managed with a “screen-and-treat” or “see-and-treat” strategy to ensure high compliance.
LMICs need to develop population-based organized CC screening program along with an electronic database for target age group. Strengthening various services within the existing health infrastructure and adequate supervision and monitoring are important factors to develop a successful screening program. Governments in such countries need to develop a pilot program to assess the feasibility of a screening method followed by gradual nationwide scale-up. Awareness should be created to develop health-seeking behavior among the community.
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References
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC cancer base no. 11. Lyon: International Agency for Research on Cancer; 2013.
Farmer P, Frenk J, Knaul FM, Shulman LN, Alleyne G, Armstrong L, et al. Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet. 2010;376(9747):1186–93.
IARC: GLOBOCAN 2012 Cervical cancer: estimated incidence, mortality and prevalence worldwide in 2012.
Sullivan T, Sullivan R, Ginsburg OM. Screening for cancer: considerations for low- and middle-income countries. In: Gelband H, Jha P, Sankaranarayanan R, Horton S, editors. Cancer: disease control priorities, vol. 3. 3rd ed. Washington: The International Bank for Reconstruction and Development/The World Bank; 2015.
Albow R, Kitchener H, Gupta N, Desai M. Cervical screening in England: the past, present, and future. Cancer Cytopathol. 2012;120:87–96.
Cuzick J, Clavel C, Petry KU, Meijer CJ, Hoyer H, Ratnam S, et al. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer. 2006;119:1095–101.
Haghighi F, Ghanbarzadeh N, Ataee M, Sharifzadeh G, Mojarrad JS, Najafi-Semnani F. A comparison of liquid-based cytology with conventional Papanicolaou smears in cervical dysplasia diagnosis. Adv Biomed Res. 2016;5:162. e Collection 2016.
Denny L, Kuhn L, Pollack A, Wainwright H, Wright TC. Evaluation of alternative methods of cervical cancer screening for resource-poor settings. Cancer. 2000;89:826–33.
Sancho-Garnier H, Khazraji YC, Cherif MH, Mahnane A, Hsairi M, El Shalakamy A, et al. Overview of cervical cancer screening practices in the extended Middle East and North Africa countries. Vaccine. 2013;31(Suppl 6):G51–7.
Aswathy S, Quereshi MA, Kurian B, Leelamoni K. Cervical cancer screening: current knowledge & practice among women in a rural population of Kerala, India. Indian J Med Res. 2012;136:205–10.
Ahmed T, Ashrafunnessa RJ. Development of a visual inspection programme for cervical cancer prevention in Bangladesh. Reprod Health Matters. 2008;16(32):78–85.
Nessa A, Hussain MA, Rahman JN, Rashid MH, Muwonge R, Sankaranarayanan R. Screening for cervical neoplasia in Bangladesh using visual inspection with acetic acid. Int J Gynaecol Obstet. 2010;111:115–8.
Heath Bulletin, MIS, Directorate General of Health Services, Dhaka, Bangladesh, 2017; Preliminary Pre-Print Version.
Arbyn M, Rebolj M, De Kok IM, Fender M, Becker N, O’Reilly M, et al. The challenges of organising cervical screening programmes in the 15 old member states of the European Union. Eur J Cancer. 2009;45:2671–8.
Adegoke O, Kulasingam S, Viring B. Cervical cancer trends in the United States: a 35-year population-based analysis. J Women Health (Larchamt). 2012;21:1031–7.
Sasieni P, Castanon A, Cuzick J. Effectiveness of cervical screening with age: population-based case-control study of prospectively recorded data. BMJ. 2009;339:b2968.
Robyr R, Nazeer S, Vasoilakos P, Matute JC, Sando Z, Halle G, et al. Feasibility of cytology-based cervical cancer screening in rural Cameroon. Acta Cytol. 2002;46:1110–6.
Sankaranarayanan R, Nessa A, Esmy PO, Dangou JM. Visual inspection methods for cervical cancer prevention. Best Pract Res Clin Obstet Gynaecol. 2012;26(2):221–32.
Nessa A, Nahar KN, Begum SA, Anwary SA, Hossain F, Nahar K. Comparison between visual inspection of cervix and cytology-based screening procedures in Bangladesh. Asian J. 2013;14(12):7607–11.
Sankaranarayanan R, Wesley R, Thara S, Dhakad N, Chandralekha B, Sebastian P, et al. Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol’s iodine (VILI) in cervical cancer screening in Kerala, India. Int J Cancer. 2003;106:404–8.
Karimi-Zarchi M, Peighmbari F, Karmi N, Rohi M, Chiti Z. A comparison of 3 ways of conventional pap smear, liquid-based cytology and colposcopy vs cervical biopsy for early diagnosis of premalignant lesions or cervical cancer in women with abnormal conventional pap test. Int J Biomed Sci. 2013;9(4):205–10.
Holowaty P, Miller AB, Rohan T, To T. Natural history of dysplasia of the uterine cervix. J Natl Cancer Inst. 1999;91(3):252–8.
Ronco G, Dillner J, Elfström KM, Tunesi S, Snijders PJ, Arbyn M, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet. 2014;383:524–32.
Meijer CJ, Berkhof J, Castle PE, Hesselink AT, Franco EL, Ronco G, et al. Guidelines for human papillomavirus DNA test requirements for primary cervical cancer screening in women 30 years and older. Int J Cancer. 2009;124:516–20.
Cuzick J, Arbyn M, Sankaranarayanan R, Tsu V, Ronco G, Mayrand MH, et al. Overview of human papillomavirus-based and other novel options for cervical cancer screening in developed and developing countries. Vaccine. 2008;26(Suppl 10):K29–41.
Sankaranarayanan R, Basu P, Wesley RS, Mahe C, Keita N, Mbalawa CC, et al. Accuracy of visual screening for cervical neoplasia: results from an IARC multicenter study in India and Africa. Int J Cancer. 2004;110:907–13.
Sankaranarayanan R, Gaffikin L, Jacob M, Sellors J, Robles S. A critical assessment of screening methods for cervical neoplasia. Int J Gynaecol Obstet. 2005;89(Suppl 2):S4–12.
Sankaranarayanan R, Nene BM, Shastri SS, Jayant K, Muwonge R, Budukh AM, et al. HPV screening for cervical cancer in rural India. N Engl J Med. 2009;360:1385–94.
Jeronimo J, Bansil P, Lim J, Peck R, Paul P, Amador JJ, et al. A multicountry evaluation of care HPV testing, visual inspection with acetic acid, and papanicolaou testing for the detection of cervical cancer. Int J Gynecol Cancer. 2014;24(3):576–85.
Shastri SS, Mittra I, Mishra GA, Gupta S, Dikshit R, Singh S, et al. Effect of VIA screening by primary health workers: randomized controlled study in Mumbai, India. J Natl Cancer Inst. 2014;106(3). https://doi.org/10.1093/jnci/dju009.
University of Zimbabwe, JHPIEGO Cervical Cancer Project Visual inspection with acetic acid for cervical cancer screening: test qualities in a primary-care setting. Lancet. 1999;353:869–73.
Denny L, Kuhn L, Pollack A, Wright TC Jr. Direct visual inspection for cervical cancer screening: an analysis of factors influencing test performance. Cancer. 2002;94:1699–707.
Sankaranarayanan R, Thara S, Anjali S, Roy C, Shastri S, Mahé C, et al. Accuracy of conventional cytology: results from a multicenter screening study in India. J Med Screen. 2004;11:77–84.
Braganca JF, Derchain SFM, Sarian LO, Messias da Silva SM, Labatte S, Zeferino LC. Aided visual inspection with acetic acid (VIA) and HPV detection as optional screening tools for cervical cancer and its precursor lesions. Clin Exp Obstet Gynecol. 2005;32:225–9.
Ngoma T, Muwonge R, Mwaiselage J, Kawegere J, Bukori P, Sankaranarayanan R. Evaluation of cervical visual inspection screening in Dar es Salaam, Tanzania. Int J Gynecol Obstet. 2010;109:100–4.
Muwonge R, Manuel MG, Filipe AP, Dumas JB, Frank MR, Sankaranarayanan R. Visual screening for early detection of cervical neoplasia in Angola. Int J Gynecol Obstet. 2010;111:68–72.
Sauvaget C, Fayette JM, Muwonge R, Wesley R, Sankaranarayanan R. Accuracy of visual inspection with acetic acid for cervical cancer screening. Int J Gynaecol Obstet. 2011;113:14–24.
Bradford L, Goodman A. Cervical cancer screening and prevention in low-resource setting. Clin Obstet Gynecol. 2013;56:76–87.
World Health Organization. WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. Geneva: World Health Organization; 2013.
World Health Organization. Comprehensive cervical cancer control: a guide to essential practice. 2nd ed. Geneva: World Health Organization; 2014.
Parham GP, Mwanahamuntu MH, Kapambwe S, Muwonge R, Bateman AC, Blevins M, et al. Population-level scale-up of cervical cancer prevention services in a low-resource setting: development, implementation, and evaluation of the cervical cancer prevention program in Zambia. PLoS One. 2015;10:e0122169.
Holme F, Kapambwe S, Nessa A, Partha B, Murillo R, Jeronimo J. Scaling up proven innovative cervical cancer screening strategies: challenges and opportunities in implementation at the population level in low and lower-middle income countries. Int J Gynecol Obstet. 2017;138(Suppl 1):63–8.
Basu P, Nessa A, Majid M, Rahman JN, Ahmed T. Evaluation of the National Cervical Cancer Screening Programme of Bangladesh and the formulation of quality assurance guidelines. J Fam Plann Reprod Health Care. 2010;36:131–4.
Nessa A, Wistrand C, Begum SA, Thuresson M, Shemer I, Thorsell M, et al. Evaluation of stationary colposcope and the Gynocular, by the Swede score systematic colposcopic system in VIA positive women: a crossover randomized trial. Int J Gynecol Cancer. 2014;24(2):339–45.
Prevention of cervical cancer through screening using visual inspection using acetic acid (VIA) and treatment with cryotherapy: a demonstration project in six African countries: Malawi, Madagascar, Nigeria, Uganda, the United Republic of Tanzania and Zambia. World Health Organization (WHO), International Agency for Research on Cancer (IARC), African Population and Health Research Center (APHRC). Geneva: World Health Organization; 2012.
Nessa A, Naud P, Esmy PO, Joshi S, Rema P, Wesley R, et al. Efficacy, safety, and acceptability of thermal coagulation to treat cervical intraepithelial neoplasia: pooled data from Bangladesh, Brazil and India. Clin Gynecol Obstet. 2017;6(3–4):58–64.
Josi S, Kulkarni V, Somanathan T, Divate U. Screening of cervical neoplasia in HIV-infected women in India. AIDS. 2013;27(4):607–15.
Sankaranarayanan R, Keshkar V, Kothari A, Kane S, Fayette JM, Shastri S. Effectiveness and safety of loop electrosurgical excision procedure for cervical neoplasia in rural India. Int J Gynaecol Obstet. 2009;104:95–9.
Nene BM, Hiremath PS, Kane S, Fayette JM, Shastri SS, Sankaranarayanan R. Effectiveness, safety, and acceptability of cryotherapy by midwives for cervical intraepithelial neoplasia in Maharashtra, India. Int J Gynaecol Obstet. 2008;103:232–6.
Sankaranarayanan R, Rajkumar R, Esmy PO, Fayette JM, Shanthakumary S, Frappart L, et al. Effectiveness, safety and acceptability of ‘see and treat’ with cryotherapy by nurses in a cervical screening study in India. Br J Cancer. 2007;96:738–43.
Sankaranarayanan R, Esmy PO, Rajkumar R, Muwonge R, Swaminathan R, Shanthakumari S, et al. Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial. Lancet. 2007;370:398–406.
Nessa A, Rashid MH, Ferdous NE, Chowdhury A. Screening for and management of high-grade cervical intraepithelial neoplasia in Bangladesh: a cross-sectional study comparing two protocols. J Obstet Gynaecol Res. 2013;39:564–71.
Acknowledgments
We are very much grateful to the International Agency for Research on Cancer (IARC), Lyon, France, including Dr. R. Sankaranarayanan and Dr. Partha Basu, and the World Health Organization for permitting us to use photographs, cancer statistics, and figures in the manuscript.
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Nessa, A., Anwar, B.R., Begum, S.A. (2019). Cervical Cancer Screening in Low-Resource Settings. In: Mehta, S., Singla, A. (eds) Preventive Oncology for the Gynecologist. Springer, Singapore. https://doi.org/10.1007/978-981-13-3438-2_14
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