Screening for Cervical Cancer in Low-Resource Countries

The World Health Organization (WHO) has outlined prerequisites necessary to determine if a mass screening programme should be developed. This chapter reviews the evidence for each of these prerequisites as they pertain to cervical cancer, with particular attention to low-resource settings. The evidence for cervical screening to prevent cervical cancer is based on a review of literature published between 2000 and 2011. The level of evidence supporting the use of three types of screening tests (cervical cytology, visual inspection, HPV testing), diagnosis (with colposcopy and biopsy), and treatment (with cryotherapy, laser, LEEP, cold-knife cone biopsy, or hysterectomy) is examined as a means of preventing cervical cancer or downstaging the disease. The benefits of a population-based programme are described and supported by examples of such programmes of in low-resource countries. In those jurisdictions where cervical cancer is a major cause of cancer incidence and mortality, the optimal approach is an organized screening programme. For low-resource settings, a “see-and-treat” approach with either VIA or careHPVTM followed by cryotherapy is the most cost-effective strategy.