Expanding Prevention of Cervical Cancer in Low- and Middle-Income Countries

Abstract Cervical cancer causes over a quarter of a million deaths in women, over 85% of whom live in developing countries, yet is an eminently preventable disease. However, cytology-based programs which have been successfully implemented require an infrastructure that is beyond the capacity of most poor countries, where preventable diseases compete with many others for resources. In the past 20 years, alternatives to cytology-based programs have been extensively explored, particularly using visual inspection methods and human papillomavirus (HPV) DNA testing, among many others. HPV DNA testing either as a primary screen or a cotest, has been shown to have a consistently high sensitivity albeit lower specificity than cytology. The technology to make HPV DNA testing accessible has advanced exponentially and there now exists a point-of-care test that gives a result within an hour and allows on site testing with reproducible accuracy, leading to on site treatment, so-called “screen and treat.” Screen-and-treat offers the opportunity to expand coverage of appropriately aged women (>30 years) and may offer the means to reduce the incidence of and mortality from cervical cancer.