Preventing cervical cancer in low-resource settings

This edition outlines the issues that must be considered when providing cervical cancer prevention services, and summarises experiences and lessons learned from programs in developing countries. Much of the information has been adapted from the second edition of PATH’s Planning Appropriate Cervical Cancer Prevention Programs.

The paper demonstrates that the demand for programs to combat cervical cancer is strong. While many countries have expended their scarce resources on providing surgical and radiotherapy services to a very small proportion of these women, there is little they can do for most cancer patients but provide palliative care. It argues that, at a minimum, programs must plan to achieve the goals listed below to reduce cervical cancer incidence and mortality:

• increase awareness of cervical cancer and preventive health-seeking behaviour among women in their thirties and forties
• screen all women aged 35 to 50 at least once before expanding services to other age groups or decreasing the interval between screening
• treat women with high-grade lesions, refer those with invasive disease where possible, and provide palliative care for women with advanced cancer
• collect service delivery statistics that will facilitate ongoing monitoring and evaluation of program activities and outputs

At the same time support for general STI control efforts will contribute to preventing a portion of cervical cancer cases in the long term. Key activities for achieving these minimum program goals in many low-resource settings include:

• coordinating cervical cancer prevention services with health programs that offer related services and/or reach women in their thirties and forties
• identifying and addressing bottlenecks to effective service delivery (for example, inadequate cytology services or inadequate information systems) before initiating a new program
• removing regulatory barriers to broadening access to services, such as regulations that do not allow nurses, midwives, or other paramedical workers to provide screening services
• ensuring that providers at all levels are trained in all aspects of cervical cancer prevention, including counselling skills
• using innovative, culturally appropriate, field-tested strategies to reach underserved older women
• supporting targeted research on new screening and treatment approaches that may increase access to services and cut program costs