This article discusses cervical cancer prevention issues in the developing world and suggests that see-and-treat cervical cancer screening, because it is simple and affordable, may be the best cancer prevention method for those regions. The authors call for data on the effectiveness of such screening programs in HIV-infected women to inform best practice guidelines.
Cervical cancer is the second most common cancer in women worldwide, and 85% of the global burden is in the developing world. Pap smear screening programs have been successful in developed countries, but are logistically difficult to implement in developing countries. Visual screening tests, on the other hand, are safe and low in cost, and also allow treatment or referral to occur in the same health care visit. Treatment options for cervical precancer include cryotherapy and loop electrosurgical excision procedure (LEEP), which may have higher rates of treatment failure in HIV-infected women, but do not appear to have higher rates of complications following treatment.
The article discusses other special considerations including age and frequency of screening, poorer performance of visual screening tests in menopausal women, the possibility of overtreatment, and increased risk of HIV acquisition or transmission following treatment.
The authors call for additional data on the effectiveness of see-and-treat cervical cancer programs, especially regarding interventions targeted at HIV-infected women, while emphasizing that primary prevention through HPV vaccination should remain a priority.