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Indian Journal of Cancer, Vol. 47, No. 3, July-September, 2010, pp. 344-345 Letter To Editor Cervical cancer screening in developing countries Patra S, Panda D1 Department of Epidemiology and Public Health, LRS Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi-30, 1 Department of Medical Oncology, Dr. BRAIRCH, AIIMS, New Delhi-29, India Code Number: cn10081 PMID: 20587915 DOI: 10.4103/0019-509X.64704 Sir, In India, cervical cancer is one of the most common cancers reported in all the cancer registries. Despite advances in early detection and prevention of cervical cancer, women living in rural areas of developing countries, including India, have had consistently higher rates of cervical cancer mortality than their counterparts during the past several decades. The potential pathways underlying this excess mortality are high prevalence of human papillomavirus (HPV), lack of or infrequent screening leading to advanced disease at diagnosis, and underuse of recommended treatment. [1] The increased risk of late reporting is usually found among women who have lower education. [2] In a cluster randomized, controlled trial in rural India, researchers [3] evaluated the effects of a single round of HPV screening on the rates of advanced cervical cancer and cervical cancer deaths. More than 130,000 women (age range, 30-59 years) were assigned to 4 groups: HPV testing, cytologic testing, visual cervical inspection with acetic acid (VIA), and control group or no screening (the current standard of care in this area of India). The women in the control group received information about how to obtain screening. Women screened for either HPV or abnormal cells had fewer cervical cancers in the following 8 years of follow-up compared with unscreened women. Rates of advanced cervical cancer and cancer-related deaths also were substantially lower in the HPV-screened group than in the cytologic-screened and VIA-screened groups. Other studies also have shown that HPV screening is much more sensitive than cytologic testing for the detection of precancerous conditions. [4],[5] The findings of this study [3] have tremendous health implications for developing countries. Single rounds of HPV screening are much easier to implement than repetitive cytologic screening, particularly in resource-poor countries where cervical cancer is relatively common. The use of mobile units may be helpful for rapid achievement of higher screening coverage in rural areas, where existing screening services cannot effectively cover the female population at risk as found by Swaddiwudhipong et al in the Thai study. [6] The mobile unit also can be used for community-based cancer awareness education program, which is sensitive to religious and cultural needs. In the developing countries, HPV testing can be used as a primary screening method, and VIA and Pap smear as methods to evaluate HPV-positive women. We also need to bear in mind that the choice of screening method for a country depends on the prevalence of the underlying disease, overall capacity of the health system, and the availability of trained health care professionals. Screening for cervical cancer is not only a secondary prevention in detecting precancerous lesions, it is also a primary prevention in detecting signs of HPV infection before precancerous lesions develop. Nations implementing the screening methods also have to develop an optimal outpatient management for HPV-positive women, including treatment for those with precancerous lesions and a close follow-up for the rest. References
Copyright 2010 - Indian Journal of Cancer |
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