Unlocking early detection: How screening can save lives from cervical cancer

Abstract

Cervical cancer remains a significant public health challenge, particularly in low- and middle-income countries. Screening of cervical cancer is crucial because it can detect precancerous changes and early-stage cancer. Regard to the screening methods, combination of human papillomavirus (HPV) testing and cytological examination has superior sensitivity and specificity compared to cytology alone. Thus, recent guidelines recommend this combined approach instead of cytology alone to reduced cervical cancer incidence and mortality. By using this combination, HPV testing identifies high-risk strains associated with cervical cancer, while cytology helps detect abnormal cellular changes. This dual strategy enhances early detection rates, allowing for timely intervention and treatment. Moreover, recent studies demonstrated that this screening strategy also significantly reduced detection costs, indicating the potential for this screening strategy to be promoted, especially in economically constrained regions. Despite challenges in screening, such as accessibility, public awareness, and cultural attitudes, educating communities on the importance of HPV testing and cytology can improve participation rates. Overall, a combined HPV testing and cytology screening strategy represents a proactive approach to cervical cancer prevention, promising to save lives through early detection and treatment.

Key Words: Human papillomavirus; Human papillomavirus testing; Cytology; Early detection; Cervical cancer

Core Tip: The combination of human papillomavirus testing and cytological examination allows for a comprehensive assessment of cervical health, targeting high-risk individuals more effectively. By identifying both human papillomavirus infections and abnormal cell changes, this strategy ensures timely follow-up and intervention for those at increased risk of developing cervical cancer. The study’s results indicate promising detection rates for precancerous lesions, demonstrating that this integrated approach can lead to a more accurate diagnosis and ultimately save lives.

INTRODUCTION

Cervical cancer is a significant public health challenge worldwide[1,2], especially in low- and middle-income countries where early screening and preventive healthcare is often limited[3-5]. Human papillomavirus (HPV) infection is the primary cause of cervical cancer[6,7], responsible for approximately 70% of cases[8,9]. HPV testing has become an effective screening method, particularly in combination with cytological examination, markedly reduced the incidence and mortality associated with cervical cancer compared to traditional screening methods that rely on cytology (Pap smear) only. Specifically, HPV testing identifies high-risk HPV strains directly linked to cervical cancer[10,11], while cytology detects cellular changes in the cervix that may indicate pre-cancerous or cancerous lesions[12]. Therefore, the rationale behind this combined approach is that while cytology identifies existing abnormalities, HPV testing offers valuable insight into the potential risk of future disease development. By combining these two modalities, we can enhance the accuracy and efficacy of cervical cancer screening programs.

Recently, Zu et al[13] conducted a clinical trial on cervical cancer screening (the trial can be found at https://www.chictr.org.cn/, with the registration number ChiCTR2400090454). The specific screening methods included gynecological examination, vaginal secretion examination, and HPV high-risk type detection. For individuals who test positive for HPV types other than 16 and 18, a cervical cytology examination (ThinPrep cytology test) is performed. For individuals who are positive for HPV16 and 18, as well as those who test positive on the ThinPrep cytology test, a colposcopic examination is conducted. If the results of the colposcopy are abnormal, a histopathological examination is performed subsequently. From 2019 to 2022, a total of 523437 women aged 35-64 participated in the screening. The cost-effectiveness and risks of the screening had been evaluated. Encouragingly, the results demonstrated that combining HPV testing with colposcopy not only increased the detection rates of cervical precancerous lesions and early cervical cancer, but also reduced the associated testing costs[14]. This finding could serve as a promising breakthrough and providing a practical framework that has potential to transform cervical cancer prevention efforts worldwide.

IMPORTANT DISCOVERIES

From 2019 to 2022, a total of 523437 women aged 35-64 participated the clinical trial on cervical cancer screening. The findings are noteworthy. Among 523437 screened women, 73313 women tested positive for HPV, with a positivity rate of 14% (73313/523437). Next, detection rate for precancerous lesions and cervical cancer were 0.6% and 0.037%, respectively. The incidence rate was reduced to half during the second examination of the 311212 patients, which is a strong indicator of the program’s success. This suggests that regular screening not only identifies suspicious but also helps in the preventive aspect of healthcare, reinforcing the importance of continued engagement with the population[15-17].

Economically, the study offers valuable insights with its cost-benefit analysis conducted over four years. The average cost for screening at 120 RMB individually (approximately 17 dollars) is reasonable, especially considering the average cost of detecting early cases is 10619 RMB (1500 dollars). The early detection cost coefficient of 0.083 underscores the economic viability of the screening program. By demonstrating that the cost of prevention is significantly lower than the potential costs associated with treating advanced cervical cancer, the study makes a compelling case for investing in screening programs, particularly in regions with limited healthcare resources[18,19]. Moreover, the findings emphasize the importance of education and awareness in enhancing the uptake of screening programs. There is a need for community engagement strategies that inform women about the risks of cervical cancer and the benefits of regular screening. Given that many women may be unaware of HPV’s role in cervical cancer or may not prioritize screening due to economic factors, public health campaigns must address these barriers directly[20,21].

EXISTED PROBLEMS AND CHALLENGES

Many women remain unaware of the importance of regular cervical cancer screening and the necessity of HPV vaccination. Public health campaigns should be developed to raise awareness about the role of HPV in cervical cancer and the critical importance of screening for early detection. These campaigns must be culturally sensitive and tailored to address the unique challenges faced by different communities, such as language barriers, stigma, and limited access to healthcare services. By doing so, we can ensure that women are better informed and empowered to take preventive measures[20,22].

Another challenge is the infrastructure and resources required for effective implementation. Healthcare systems must be adequately equipped to handle the logistical demands of dual testing. This includes training healthcare providers to interpret test results, manage follow-up care, and engage in patient education. Additionally, systems must ensure the availability of both HPV testing and cytology in various healthcare settings, including rural and underserved areas. Telehealth and mobile clinics could play a significant role in expanding access to screening, particularly in hard-to-reach populations[23,24].

Financial considerations also play a crucial role in the feasibility of combined HPV testing and cytology strategies. While the costs of HPV testing have decreased in recent years, affordability remains a barrier for many women, particularly in low-income settings. Strategies to subsidize testing, provide free or low-cost screenings, and integrate these services into existing healthcare programs are essential to ensuring equitable access. Public-private partnerships could also facilitate investment in screening infrastructure, making it more accessible to underserved populations[25,26].

CONCLUSION

In conclusion, the combined strategy of HPV testing and cytology represents a promising advancement in cervical cancer screening. Characterized by enhanced sensitivity, extended screening intervals, and patient risk stratification, this approach can significantly improve early detection rates and outcomes. However, successful implementation requires robust public health initiatives, adequate infrastructure, and financial support to ensure equitable access for all women. Through overcoming these challenges, we can pave the way for a future in which cervical cancer is no longer a leading cause of morbidity and mortality among women worldwide. Furthermore, cervical cancer could be eliminated as a public health threat through comprehensive screening strategies and preventive measures[19,27,28].

ACKNOWLEDGEMENTS

The authors would like to thank Mrs. Xi-Chen Wang (MSDChina, Shanghai, China) for providing academic information consulting support. The authors would also like to express their gratitude to Professor Kai-Yan Liu (Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou, China) for her editing and proofreading of the manuscript.