Management of abnormal pap smear and pre-invasive disease of the cervix in developing countries

Abstract

Cervical cancer ranks as the third most common cancer after breast (1.38 million cases) and colorectal cancer (0.57 million cases). In 2008, about 529,000 new cases of cervical cancer were diagnosed globally. This disease is the fourth most common cause of cancer-death (275,000 deaths) ranking below breast (458 000 deaths), lung (427 000 deaths) and colorectal cancer (288 000 deaths). Eighty-six percent of all cervical cancers and 88% of all deaths caused by cervical cancer occur in developing countries.1 In sub-Saharan Africa, cervical cancer ranks the second most common cancer among women. In the year 2012, out of the estimated 370,138 cancers in sub- Saharan African women, about 93,200 new cases of cervical cancer (25.2% of cancers) were recorded. The lowest burden of cervical cancer was reported in Australia, Northern America and Western Europe with an age-standardised incidence rate of 5.0, 5.7 and 6.9/100 000, respectively. The low incidence of cervical cancer in these regions has been attributed to the establishment of an effective cervical cancer screening programme. A strong correlation between the initiation of cytology screening and a reduction in the incidence and mortality from cervical cancer have been demonstrated in countries like Denmark, Finland, Iceland, Norway and Sweden, The introduction of these screening modalities was based on the knowledge that invasive cervical cancer is preceded by an interval of epithelial dysplastic changes, typically occurring at the transformation zone. While the age-standardised incidence rate of cervical cancer in Nigeria has increased to over 30/100 000, much needs to be done to indigenize the experience from these successful screening programmes taking into cognizance the peculiarity of our environment.