Cervical Cancer Screening Methods and Challenges in Low Resource Settings

Running head: PUBLIC HEALTH
Public health
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1PUBLIC HEALTH
Answer 1:
According to the worldwide prevalence data for cervical cancer in 2012, it is the fourth
most common cause of cancer in women. About 5, 28, 000 newly diagnosed cases of cervical
cancer were found in the year 2012 and the high risk regions for cervical cancers included
Eastern and Middle Africa. In that year, cervical cancer was responsible for 266, 000 deaths and
it accounted to 7.5% death in female due to cancer. Another common trend that was seen from
the data was that most of people diagnosed with cervical cancer came for lesser developed
countries (Globocan.iarc.fr. 2012). In case of recent statistics on cervical cancer in Australia, in
2018, 1.5% new female cancer cases were diagnosed in 2018. It is regarded as the 14th most
diagnosed cancer among females in Australia (canceraustralia.gov.au 2018).
Answer 2:
Cervical cytololgy is the gold standard screening methods for screening of cervical
cancer in all developed countries. It is also called Pap test or pap smear test. It is a fast and
simple screening methods which involves taking cells from the cervix and sending the cell for
laboratory testing. The main purpose of the cervical cytology is to examine presence of abnormal
cells in smear. The method had significant impact on cervical cancer morbidity and mortality
rate. However, currently more specific test called human papillomavirus (HPV) testing is also
done due to the limitations of Pap smear. Pap smear is found to have low sensitivity, high false
negatives rates and interobserver variability. Research study also revealed other limitations such
as interobserver bias and chances of misinterpretation of results. It does not work in low resource
setting too because of lack of infrastructure and highly trained personnel to examine the smear.

2PUBLIC HEALTH
For this reason, cytologic testing requires regular examination and follow up with patients too
(Boone, Erickson and Huh 2012).
Answer 3:
The alternative screening methods for cervical cancer in low resource setting includes
HPV testing or visual inspection with acetic acid followed by cryotherapy. Visual inspection
with acetic acid is the second option for screening when HPV testing is not available in a region.
The HPV testing was identified as an alternative screening method when many barriers were
found in cytology based screening low resources areas. For instance, in low resource regions like
Pacific islands, people found it hard to travel to remote areas for screening. This region also
lacked proper infrastructure for testing such as lack of high quality cytology system and
pathology lab. Hence, screening for women with HPV testing with or without visual inspection
with acetic acid was recommended by WHO. HPV testing has been found effective in reducing
cervical cancer mortality and late-stage illness in studies done in India, Europe and Africa. The
logistical barrier to the test can also be addressed by use of point-of-care HPV test ( Elit, Ogilvie
and Lee 2017).
Answer 4:
Other alternatives like HPV testing has been evaluated by means of cost-effectiveness
and ease of access parameters. Screening test sensitivity and population coverage were also
evaluated before proposing it as an alternative option for screening in low resource setting.
Primary prevention is now done with HPV testing because a trial showed that HPV was a more
cost effective and sensitive method. It had sensitivity of 96%. Furthermore, combining it with
other screening methods enhanced detection pre-invasive lesions. In terms of ease of testing and