Cervical Cancer Prevention and Treatment in Low-Resource Settings

In a recent analysis based on the 2008 worldwide estimates of cancer compiled by the International Agency for Research on Cancer (IARC, Lyon, France)1, it was estimated that 529,512 women were diagnosed with cervical cancer corresponding to an age-standardized incidence rate (ASIR) of 15.4/100,000 and 274,967 women died of the disease, with an age-standardized mortality rate (ASMR) of 7.8/100,0002. The majority of the cases diagnosed (n = 453,032; 85.5%) were found in developing countries, as were the deaths (n = 241,818; 87.9%). Globally, cervical cancer was the third most common cancer ranking after breast (1.3 million cases) and colorectal cancer (0.57 million cases) and the fourth most common cause of cancer death ranking below breast, lung and colorectal cancer. There is a striking disparity in the incidence of and mortality from cervical cancer in different regions of the world. Figure 1 shows the annual number of deaths from cervical cancer in developed and developing regions by age group, and it is evident that the number of deaths in developing countries is nearly 10 times greater than in developed regions. In Africa, which has a population of 267.9 million women aged 15 years and older at risk of developing cervical cancer, approximately 80,000 women are diagnosed with cervical cancer per year, and just over 60,000 women die from the disease1. However, cervical cancer incidence in Africa also varies considerably by region. The highest rates in Africa (ASIR >40/100,000) are all found in Eastern, Southern or Western Africa (Figure 2). In addition, there are marked variations within regions themselves as illustrated in Figure 3 for Southern Africa1, where the highest incidence is found in Lesotho and Swaziland, two countries that have neither screening programs nor any anti-cancer treatment facilities and who have 1 and 2 doctors per 10,000 population, respectively (compared to 8/10,000 in South Africa and 27/10,000 in the USA)3. 26