title: Cervical cancer prevention in low- and middle-income countries: feasible, affordable, essential.
abstract: The annual worldwide burden of the preventable disease cervical cancer is more than 530,000 new cases and 275,000 deaths, with the majority occurring in low- and middle-income countries (LMIC), where cervical cancer screening and early treatment are uncommon. Widely used in high-income countries, Pap smear (cytology based) screening is expensive and challenging for implementation in LMICs, where lower-cost, effective alternatives such as visual inspection with acetic acid (VIA) and rapid human papillomavirus (HPV)-based screening tests offer promise for scaling up prevention services. Integrating HPV screening with VIA in "screen-and-treat-or-refer" programs offers the dual benefits of HPV screening to maximize detection and using VIA to triage for advanced lesions/cancer, as well as a pelvic exam to address other gynecologic issues. A major issue in LMICs is coinfection with human immunodeficiency virus (HIV) and HPV, which further increases the risk for cervical cancer and marks a population with perhaps the greatest need of cervical cancer prevention. Public-private partnerships to enhance the availability of cervical cancer prevention services within HIV/AIDS care delivery platforms through initiatives such as Pink Ribbon Red Ribbon present an historic opportunity to expand cervical cancer screening in LMICs.
authors.affiliation: Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, 2525 West End Avenue, Nashville, TN 37203, USA.
authors.forename: Vikrant V
authors.initials: VV
authors.lastname: Sahasrabuddhe
authors.forename: Groesbeck P
authors.initials: GP
authors.lastname: Parham
authors.forename: Mulindi H
authors.initials: MH
authors.lastname: Mwanahamuntu
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
mesh_terms: D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer; D005260:Female; D014943:Global Health; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008495:Medical Oncology / Q000379:methods; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000150:complications; D011203:Poverty; D011315:Preventive Medicine / Q000379:methods; D012306:Risk; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000191:economics / Q000517:prevention & control*; D014626:Vaginal Smears / Q000191:economics / Q000379:methods