Evidence-based Screening, Early Diagnosis and Treatment Strategy of Cervical Cancer for National Policy in Lowresource countries: Example of India

Abstract

Cervical cancer remains the most frequent cancer in women from the developing world. More than 88%of deaths occur in low-income countries, and it is predicted to climb to 91.5% by 2030. Although Pap-basedscreening programmes have shown to be effective in reducing the disease burden in high-resource countries,implementation and sustention of cytology-based programmes is quite challenging in low-resource settings. Thepresent paper reviews evidence-based alternatives of screening methods, triaging algorithm, treatment of cervicalprecancerous lesions, and age-group at screening appropriate for low-income countries. Evidence shows thatvisual inspection methods using diluted acid acetic or Lugol’s iodine, and HPV-DNA testing are more sensitivetests than the Pap-smear screening test. Visual inspection allows an immediate result and, when appropriate,may be immediately followed by cryotherapy, the so called “screen-and-treat” approach, achieved in a singlevisit, by trained nurses and midwives. Examples of cervical cancer prevention programmes in India and selectedlow-income countries are given.