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http://dx.doi.org/10.7314/APJCP.2012.13.4.1699

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

Saxena, Upma (Department of Obstetric & Gynaecology, Dr Ram Manohar Lohia Hospital)
Sauvaget, Catherine (Screening Group, Early Detection and Prevention section, International Agency for Research on Cancer)
Sankaranarayanan, Rengaswamy (Screening Group, Early Detection and Prevention section, International Agency for Research on Cancer)
Publication Information
Asian Pacific Journal of Cancer Prevention / v.13, no.4, 2012 , pp. 1699-1703 More about this Journal
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-based screening 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. The present paper reviews evidence-based alternatives of screening methods, triaging algorithm, treatment of cervical precancerous lesions, and age-group at screening appropriate for low-income countries. Evidence shows that visual inspection methods using diluted acid acetic or Lugol's iodine, and HPV-DNA testing are more sensitive tests 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 single visit, by trained nurses and midwives. Examples of cervical cancer prevention programmes in India and selected low-income countries are given.
Keywords
Cervical neoplasm; screening methods; early detection; screen-and-treat approach; low-income countries;
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