A study published in the open-access journal PLoS Medicine has found that women in the developing world are not getting the cervical cancer screenings that they need. Researcher Emmanuela Gakidou (University of Washington, Seattle, USA) and colleagues report that although women in the developing world have the highest risk of developing cervical cancer, few are effectively screened. Additionally, there exist severe inequalities between and within countries concerning the access to cervical cancer screening.

As the second-most common cancer in women (after breast cancer), cervical cancer is a leading cause of death all around the world. During the last 40 years, both the number of new cases of cervical cancer and the death rate due to the disease have fallen in the developed world. Medical and health professionals point to widespread screening programs as the reason for this public health success. The developing world, however, has a higher prevalence of cervical cancer but very little information about rates of screening.

Gakidou and colleges sifted through surveys taken by the World Health Organization (WHO) in order to better understand the information problem and the degree to which access to screening services is unequal. The data came from 57 countries and all levels of economic development. The researchers defined two types of coverage measures: 1) effective coverage – measured by the percentage of women who had both a pelvic exam and a Pap smear test in the preceding three years, and 2) crude coverage – measured by the percentage of women who reported just having a pelvic exam at any time. An analysis using these measures revealed that there is a striking difference in cervical cancer screening rates between developing and developed countries: 19% in the developing world and 63% in the developed world have been screened to satisfy effective coverage.

Other noteworthy statistics from the study include:

  • In Austria, over 80% of women receive effective screening.
  • In Ethiopia and Bangladesh, 1% or less receive effective screening. .
  • Over 50% of women had never received a pelvic exam in 16 of the 57 countries analyzed.
  • 90% of women in Ethiopia, Malawi and Bangladesh have never had a pelvic exam.

Not surprisingly, those who have the highest exposure to smoking, unsafe sex, and other cervical cancer risk factors are poor women; this group is also less likely to receive effective screening. As women get older, screening rates in developing countries decline even though older women are more prone to cervical cancer,

“Improving the effective coverage of cervical cancer screening or developing alternative ways to decrease cervical cancer mortality worldwide would have a considerable impact on decreasing the disease’s burden as well as overall health inequalities. No one strategy will work everywhere, making it important to consider multiple strategies across – and likely within – countries,” conclude the authors.

Coverage of cervical cancer screening in 57 countries: Low average levels and large inequalities
Gakidou E, Nordhagen S, Obermeyer Z
PLoS Medicine (2008). 5(6): e132.
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About PLoS Medicine

PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org

About the Public Library of Science

The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world’s scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org

Written by: Peter M Crosta