Cervical cancer screening programs and guidelines in low- and middle-income countries

Abstract

Background: Screening reduces cervical cancer incidence and mortality.

Objective: To describe cervical cancer epidemiology and screening guidelines in six low- and middle-income countries (LMICs) participating in the Study on global AGEing and adult health (SAGE).

Search strategy: Incidence, mortality, and screening-rate data were obtained for six LMICs and three higher-income comparator countries (Australia, USA, and UK). SCOPUS and PubMed were used to identify literature published after 2000 in English, using several screening-linked terms.

Selection criteria: Literature describing the use of cervical cancer screening guidelines in China, Ghana, India, Mexico, Russia, and South Africa were included.

Data collection and analysis: Incidence, mortality trends, and screening rates were graphed and screening recommendations were summarized.

Main results: Higher rates of cervical cancer incidence, mortality, and 5-year prevalence were found in LMICs compared with the comparator countries. LMICs with absent or newly implemented screening guidelines had the lowest rates of crude and effective cervical cancer screening, with high cancer incidence and mortality. Countries with established guidelines had higher screening rates and lower disease burden. Cost, inadequate knowledge, geographical location, and cultural views were common barriers to effective screening coverage.

Conclusion: Work must continue to improve the implementation of affordable, relevant, and achievable methods to improve screening coverage in LMICs.

Keywords: Cervical cancer; Incidence; Lower middle income; Mortality; Pap test.