Cervical cancer is the second most common cancer in women in
developing countries. Globally some quarter of a million women die
from the disease each year - most of them from low and middle income countries (LMICs).
To reduce the incidence of cervical cancer in developed countries,
nationwide screening is offered to all women. Taking a small cluster of
cells ('cytology') to diagnose disease before it progresses to cancer
has been extremely effective.
‘Taking a small sample of cells from women at high-risk of cervical cancer could be a cost-effective and accurate strategy for early diagnosis in low and middle income countries.’
But in less developed countries, a lack of
infrastructure and quality management have hampered widespread
implementation of effective screening programs.
Taking a small sample of cells from women at high-risk of cervical
cancer could be a cost-effective and accurate strategy for early
diagnosis in low and middle income countries, according to
research led by Queen Mary University of London (QMUL), funded by Cancer
Research UK and published in the Journal of Global Oncology
In the first study to evaluate the use of cytology to diagnose
cervical cancer in LMICs, the researchers looked at cytology results
from 717 cervical cancers from 23 studies in countries including India,
Bangladesh, China, Thailand, Kenya, South Africa, Uganda, Peru, El
Salvador, Costa Rica, Nicaragua, Brazil, Argentina and Egypt. They
argued that cytology in these countries might be used to diagnose
cervical cancer earlier.
The researchers found that even in these low-resource settings,
cytology was very sensitive and consistent for detecting invasive
cancer. Cytology was found to successfully find cancer with 95.9% accuracy in high-risk women showing symptoms.
Corresponding author Dr Alejandra Castanon from QMUL said: "Cytology
has long been established as an excellent screening tool to prevent
cervical cancer by detecting precancerous lesions. However, little
research has been carried out regarding its sensitivity to cancer."
"We've found that this is an excellent tool for targeted screening
of populations at high risk of cervical cancer, leading to early
diagnosis. In resource-poor settings with limited facilities to treat
advanced cancers, this could have a big impact on cervical cancer
The researchers say that restricting cytology to symptomatic women
and referring only those with severe lesions would lead to substantially
fewer women requiring further investigation. This could mean a
reduction in burden on resource and cost, and could result in the
diagnosis of cervical cancers at an earlier stage to improve overall
survival from the disease.
Co-author Professor Peter Sasieni from QMUL added: "The implications
are that, even when a country lacks infrastructure to implement a
quality-assured cervical screening program nationally, it might be
able to facilitate early diagnosis of cervical cancer by using cervical
cytology, and only referring women with severely abnormal smears."