Lessons learned from successful Papanicolaou cytology cervical cancer prevention in the Socialist Republic of Vietnam

Abstract

In 1996, we documented that the burden of cervical cancer in Vietnam was associated with troop movements during the Vietnam War. Subsequently, establishment of Papanicolaou screening in southern Vietnam was associated with reductions in cervical cancer incidence from 29.2/100,000 in 1998 to 16/100,000 in 2003. This is one of the first English-language reports of a real-world cervical cancer prevention effort associated with a decisive impact on health outcomes in a contemporary developing country.

Lessons learned: if our ideological commitment is to improve health outcomes as rapidly as possible among as many people as possible, then Papanicolaou screening (with or without HPV or visual screening) must be implemented without further delay in any setting where cervical screening is appropriate but unavailable; consideration must be given to HPV vaccination after, rather than before, full coverage of target demographic groups by screening services has been achieved and/or the possibility has been excluded that HPV vaccination may be ineffective for cancer prevention. Competing ideological commitments engender imprudent yet commercially useful alternative strategies prone to decelerate global reductions in mortality by suppressing the more-rapid uptake of less-expensive open-source technology in favor of the less-rapid uptake of more-expensive proprietary technologies with uncertain real-world advantages and unfavorable real-world operational limitations. Global cervical cancer prevention efforts will become more effective if global health leaders, including the Bill & Melinda Gates Foundation, embrace an ideological commitment to improving health outcomes as rapidly as possible among as many people as possible and assimilate the policy implications of that commitment.

Fig 1

Ho Chi Minh City (population ∼9 million) population-based tumor registry data. Age-standardized incidence rates (ASR) per 100,000 women for cervical cancer and breast cancer in metropolitan Ho Chi Minh City, 1996–2006., – The first year for which population-based tumor registry data are available is 1996. Vietnamese leaders committed to Papanicolaou screening for Vietnam during the1997 National Conference on Cancer Prevention and Control. Tumor registry data from 2000, 2001, and 2002 are not yet available. The most recent year for which tumor registry data are available is 2006.