title: Cervical cancer screening programs and guidelines in low- and middle-income countries.
abstract: BACKGROUND
  Screening reduces cervical cancer incidence and mortality.
  
  
  OBJECTIVE
  To describe cervical cancer epidemiology and screening guidelines in six low- and middle-income countries (LMICs) participating in the Study on global AGEing and adult health (SAGE).
  
  
  METHODS
  Incidence, mortality, and screening-rate data were obtained for six LMICs and three higher-income comparator countries (Australia, USA, and UK). SCOPUS and PubMed were used to identify literature published after 2000 in English, using several screening-linked terms.
  
  
  METHODS
  Literature describing the use of cervical cancer screening guidelines in China, Ghana, India, Mexico, Russia, and South Africa were included.
  
  
  METHODS
  Incidence, mortality trends, and screening rates were graphed and screening recommendations were summarized.
  
  
  RESULTS
  Higher rates of cervical cancer incidence, mortality, and 5-year prevalence were found in LMICs compared with the comparator countries. LMICs with absent or newly implemented screening guidelines had the lowest rates of crude and effective cervical cancer screening, with high cancer incidence and mortality. Countries with established guidelines had higher screening rates and lower disease burden. Cost, inadequate knowledge, geographical location, and cultural views were common barriers to effective screening coverage.
  
  
  CONCLUSIONS
  Work must continue to improve the implementation of affordable, relevant, and achievable methods to improve screening coverage in LMICs.
authors.affiliation: Research Centre for Generational Health and Ageing, School of Medicine and Public Health, HMRI Building, University of Newcastle, Callaghan, NSW, Australia 2308.
authors.forename: Brody
authors.initials: B
authors.lastname: Olson
authors.affiliation: Research Centre for Generational Health and Ageing, School of Medicine and Public Health, HMRI Building, University of Newcastle, Callaghan, NSW, Australia 2308.
authors.forename: Beth
authors.initials: B
authors.lastname: Gribble
authors.affiliation: Research Centre for Generational Health and Ageing, School of Medicine and Public Health, HMRI Building, University of Newcastle, Callaghan, NSW, Australia 2308.
authors.forename: Jasmyni
authors.initials: J
authors.lastname: Dias
authors.affiliation: Research Centre for Generational Health and Ageing, School of Medicine and Public Health, HMRI Building, University of Newcastle, Callaghan, NSW, Australia 2308.
authors.forename: Cassie
authors.initials: C
authors.lastname: Curryer
authors.affiliation: The George Institute for Global Health, Sydney, Australia.
authors.forename: Kha
authors.initials: K
authors.lastname: Vo
authors.affiliation: Research Centre for Generational Health and Ageing, School of Medicine and Public Health, HMRI Building, University of Newcastle, Callaghan, NSW, Australia 2308; WHO Study on global AGEing and adult health (SAGE), 20 Avenue Appia, CH -1211 Geneva, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Kowal
authors.affiliation: Research Centre for Generational Health and Ageing, School of Medicine and Public Health, HMRI Building, University of Newcastle, Callaghan, NSW, Australia 2308. Electronic address: julie.byles@newcastle.edu.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Byles
mesh_terms: D003906:Developing Countries; D005260:Female; D006801:Humans; D015994:Incidence; D017410:Practice Guidelines as Topic; D015995:Prevalence; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D014626:Vaginal Smears / Q000191:economics / Q000706:statistics & numerical data; D014932:Women's Health Services; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control
keywords: Cervical cancer; Incidence; Lower middle income; Mortality; Pap test