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World J Clin Oncol. Dec 10, 2015; 6(6): 281-290
Published online Dec 10, 2015. doi: 10.5306/wjco.v6.i6.281
Cervical cancer screening in developing countries at a crossroad: Emerging technologies and policy choices
Rosa Catarino, Patrick Petignat, Gabriel Dongui, Pierre Vassilakos
Rosa Catarino, Patrick Petignat, Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, 1205 Geneva, Switzerland
Gabriel Dongui, Division of Gynaecology, Department of Gynaecology and Obstetrics, University Hospital of Yopougon, Abidjan 21 BP 632, Ivory Coast
Pierre Vassilakos, Geneva Foundation for Medical Education and Research, 1211 Geneva, Switzerland
Author contributions: Catarino R participated in drafting the article, prepared the figures and tables; Petignat P provided input in writing the paper; Dongui G participated in drafting the article; Vassilakos P participated in drafting the article and in revising it critically for important intellectual content; all authors gave final approval of the version to be submitted.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rosa Catarino, MD, Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland. rosapintocatarino@gmail.com
Telephone: +41-22-3826816 Fax: +41-22-3724188
Received: May 29, 2015
Peer-review started: May 30, 2015
First decision: August 14, 2015
Revised: September 3, 2015
Accepted: October 20, 2015
Article in press: October 27, 2015
Published online: December 10, 2015
Processing time: 194 Days and 1.6 Hours
Abstract

Cervical cancer (CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas, the burden from disease remains important because of the difficulty in implementing cytology-based screening programmes. The main obstacles inherent to these countries are poverty and a lack of healthcare infrastructures and trained practitioners. With the availability of new technologies, researchers have attempted to find new strategies that are adapted to low- and middle-income countries (LMIC) to promote early diagnosis of cervical pathology. Current evidence suggests that human papillomavirus (HPV) testing is more effective than cytology for CC screening. Therefore, highly sensitive tests have now been developed for primary screening. Rapid molecular methods for detecting HPV DNA have only recently been commercially available. This constitutes a milestone in CC screening in low-resource settings because it may help overcome the great majority of obstacles inherent to previous screening programmes. Despite several advantages, HPV-based screening has a low positive predictive value for CC, so that HPV-positive women need to be triaged with further testing to determine optimal management. Visual inspection tests, cytology and novel biomarkers are some options. In this review, we provide an overview of current and emerging screening approaches for CC. In particular, we discuss the challenge of implementing an efficient cervical screening adapted to LMIC and the opportunity to introduce primary HPV-based screening with the availability of point-of-care (POC) HPV testing. The most adapted screening strategy to LMIC is still a work in progress, but we have reasons to believe that POC HPV testing makes part of the future strategies in association with a triage test that still needs to be defined.

Keywords: Low- and middle-income countries; Cervical cancer screening; Human papillomavirus testing

Core tip: Cervical cancer (CC) burden in developing countries remains important because of the difficulty in implementing cytology-based screening programmes. With the introduction of new technologies, researchers have attempted to find new strategies for CC screening adapted to these countries. Rapid human papillomavirus (HPV) tests are one of these advantageous methods. However, HPV testing has a low positive predictive value for CC, so a triage test is needed. Visual inspection tests, cytology and novel biomarkers are some options. We provide an overview of current and emerging screening approaches for CC. We discuss the challenge of implementing an efficient CC screening adapted to developing countries and the opportunity to introduce primary HPV-based screening with the availability of point-of-care tests.