Screening of uterine cervical cancer in low-resource settings

cervical cancer is the second most common malignant disease of women worldwide, and accounts for about one tenth of the total number of female cancer deaths. Even though uterine cervical cancer has been decreased as a result of widespread use of effective screening tests for premalig-nant lesions in developed countries, the cancer burden such as incidence and mortality is disproportionately high in many less-developed countries [1,2]. The incidence of uterine cervical cancer is highly variable according to various geographic areas, especially high in East Africa, Central America, the Pacific Islands, and SouthEastern Asia, based on HPV infection and screening practice [3]. Cervical screening is accepted as the most effective tool for the control of uterine cervical cancer. However, the existing screening programs are insufficient to reach a goal in many less-developed countries [4]. In two upcoming papers, Singh et al. [5] and Nuranna et al. [6] present the important experiences for screening of uterine cervical cancer in low-resource settings of SouthEastern Asia. First, Singh et al. [5] reported poor attitudes and practices among cervical cancer screeners consisting of staff nurses, despite knowledge of the gravity of uterine cervical cancer and prevention by cytologic screening. The cytologic screening has been accepted to be effective in reducing the incidence and mortality from uterine cervical cancer in many developed countries [7]. However, several important elements are crucial for successful and effective cytologic screening. It is critical to train the relevant health care professionals-smear takers (physicians , nurses, midwives), smear readers (cytotechnologists), cytopathologists, colposcopists and program managers-for attitudes as well as practices like the issues of the report by Singh and colleagues, to ensure adequate quality of the cytologic smear. Funding should be also enough to provide efficient and high-quality laboratory services, and referral system to ensure that women with an abnormal cytology could attend for management and follow-up. Additional important issues are the priority age group to be screened, the definition of an abnormality to be treated, and the timing of subsequent screening based on nationwide budget for the public health care system [8]. Second, Nuranna et al. [6] reported successfully implemented See and Treat program as a promising way to screen and treat precancerous lesion of the uterine cervix in low-resource setting. The technical and financial limitations of cytologic screening in low-resource settings have led to the evolution of alternative screening tests such as visual inspection of the uterine cervix with 3-5% …