Effective screening programmes for cervical cancer in low- and middle-income developing countries

Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programme s - either organized or opportunistic - have led to a large decline in cerv ical cancer incidence and mortality in developed countries. In contrast, ce rvical cancer remains largely uncontrolled in high-risk developing countrie s because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing c ountries. Substantial costs are involved in providing the infrastructure, manpower, c onsumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health ca re resources, developing countries cannot afford the models of frequently r epeated screening of women over a wide age range that are used in developed countries. Many low-income developing countries, including most in sub-Sah aran Africa, have neither the resources nor the capacity for their health s ervices to organize and sustain any kind of screening programme. Middle-inc ome developing countries, which currently provide inefficient screening, sh ould reorganize their programmes in the light of experiences from other cou ntries and lessons from their past failures, Middle-income countries intend ing to organize a new screening programme should start first in a limited g eographical area, before considering any expansion. It is also more realist ic and effective to target the screening on high-risk women once or twice i n their lifetime using a highly sensitive test, with an emphasis on high co verage (> 80%) of the targeted population. Efforts to organize an effective screening programme in these developing co untries will have to find adequate financial resources, develop the infrast ructure, train the needed manpower, and elaborate surveillance mechanisms f or screening, investigating, treating, and following up the targeted women. The findings from the large body of research on various screening approach es carried out in developing countries and from the available managerial gu idelines should be taken into account when reorganizing existing programmes and when considering new screening initiatives.