Cervical cancer screening in aogin countries: what are the options?

Abstract

Cervical cancer is the 3rd most common cancer in Asian women and ranks 2nd among women in the reproductive age group. According to the suggestions of WHO, every woman in the target age group (30-49 years) should at least be screened once. HPV testing, cytology and visual inspection with acetic acid are all recommended screening tests. The most important strategy is to reach the largest proportion of women at risk with quality screening and treatment. Organized screening programmes are preferable to opportunistic screening. Cervical cytology screening has been effective in prevention of cervical cancer screening in the developed countries but the effect seems to have plateaued. The demand on well trained professionals also limits its application. In the last two decades, various technical platforms have been developed to improve the efficiency of screening. (1) Liquid based cytology to improve the quality of the sample for cyto-morphological evaluation and provide one-stop convenient and reliable material for ancillary tests. (2) High risk human papilloma virus (HR-HPV) DNA / RNA tests to detect the most important risk factor for cervical cancer and increase the sensitivity of screening. (3) Computerized imager for automated detection of abnormal cells and reduce the pressure on cytology evaluation manpower. (4) Molecular markers such as p16INK4A and Ki-67 to enhance the specificity of cancer cell detection.There is increased application of HR-HPV detection and genotyping tests in screening of cervical cancers as co-testing or primary tool followed by cytology triage. The application will become particularly beneficial in places with high HPV vaccine coverage. HPV molecular tests are also used for triage of atypical squamous cells undetermined significance and evaluation of recurrence of cervical diseases. Health professionals should be aware of the advantages and limitations of the tests that can be applied. The importance of quality control and laboratory accreditation should be emphasized. It is important to note that continuation of cervical cancer screening is necessary even in the post HPV vaccine era. There is wide variation in the economic status, health system and availability of screening infra-structures among AOGIN countries. Each country / region / city should find the screening strategy that is most suitable to ensure the success.