Cervical Cancer

Excerpt

Cervical cancer, a largely preventable disease, is one of the most common cancers found in women living in low- and middle-income countries (LMICs). A striking reduction in the incidence of and mortality from cervical cancer occurred in the past century in those countries that were able to establish successful national screening programs. These programs relied on cytology-based Papanicolaou smears to identify cervical cancer precursors that can be removed before progressing to invasive cancer. Prevention of up to 91 percent of all invasive cervical cancers has been achieved in countries able to implement widespread cytology-based screening.

However, these programs are expensive and require robust and well-funded health care systems. Few LMICs have initiated or sustained cytology-based cervical cancer prevention programs, and these countries experience very high incidence and mortality rates. The unequal burden of cervical cancer is an example of the impact of unequal access to health care. Fortunately, alternative strategies to prevent cervical cancer have been investigated and extensively evaluated in these settings. The recent introduction of two commercially available vaccines against human papillomavirus (HPV) has offered the possibility of primary prevention of cervical cancer. This chapter focuses on these innovations.