Cervical screening strategies in resourced and resource-constrained countries.

Area of Science:

• Oncology
• Public Health
• Gynecology

Background:

• Cervical cancer screening is standard in high-resource countries, primarily using Pap tests and human papillomavirus (HPV) DNA tests.
• Screening coverage remains suboptimal in many developed nations, with few achieving the target of 80% or higher.
• In resource-constrained countries, national cervical cancer screening programs are largely absent, despite high incidence rates.

Purpose of the Study:

• To review current cervical cancer screening and treatment strategies.
• To identify effective approaches for resource-constrained settings.
• To highlight challenges in achieving adequate screening coverage globally.

Main Methods:

• Review of established and emerging cervical cancer screening and treatment modalities.
• Analysis of the applicability of different methods in resource-limited contexts.
• Discussion of the potential of new biomarkers and 'super tests' for less frequent application.

Main Results:

• The Pap test and HPV DNA test are mainstays in resourced countries, with HPV tests offering adjunctive benefits.
• Resource-constrained countries are exploring 'screen and treat' approaches, including visual inspection with acetic acid (VIA) and HPV testing.
• Visual inspection with acetic acid (VIA) and HPV testing are key screening methods under investigation for low-resource settings.
• Cryotherapy and large loop excision of the transformation zone (LLETZ) are common treatment methods.
• The combination of HPV testing and LLETZ is considered ideal, contingent on the availability of a low-cost HPV test.

Conclusions:

• Effective cervical cancer screening and treatment are critical, especially in resource-constrained countries where incidence is high.
• Improving screening coverage is an urgent priority in low-resource settings.
• The development of affordable, accurate HPV tests is crucial for implementing effective screening and treatment programs globally.
• Addressing cervical cancer requires balancing it with other pressing healthcare needs in resource-limited environments.