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Cervical Cancer Prevention and Control in Low and Middle-Income Countries (LMICs).

Dr. Sukanya Mehra, Ph.D.

Background: Cervical cancer poses a significant risk to women’s health in low- and middle-income countries (LMICs), where limited access to healthcare services highlights the issue. Despite being preventable, this disease remains a leading cause of cancer-related deaths among women in low- and middle-income countries (LMICs). Regardless of significant advancements in cervical cancer screening, low- and middle-income countries (LMICs) continue to lag high-income countries in reducing cervical cancer incidence and mortality. The World Health Organization’s (WHO) call to eliminate cervical cancer as a public health problem, anchored by the 90-70-90 strategy: 90% of girls fully vaccinated with the HPV vaccine by age 15, 70% of women screened with a high-performance test by age 35 and again by 45 and 90% of  women with pre-cancer treated and 90% of women with invasive cancer managed¹. Achieving this goal in LMICs requires tailored solutions to address the specific challenges and barriers to cervical cancer control in these settings. Due to inadequate healthcare infrastructure, limited resources, and cultural factors that hinder access to healthcare services, LMICs face significant obstacles in combating cervical cancer^2,3.

Human papillomavirus (HPV) infection is the primary cause of cervical cancer⁴. If left untreated, the virus can lead to abnormal cell growth on the cervix, potentially progressing to cancer. Eliminating cervical cancer relies on a two-pronged strategy: primary prevention through HPV vaccination and secondary prevention through screening programs and treatment of pre-invasive disease⁵. Since its introduction in the early 2000s, the HPV vaccine has led to significant reductions in HPV-related diseases, particularly in high-income countries. However, access to the vaccine in low- and middle-income countries (LMICs) remains inconsistent, ranging from small-scale projects to national programs⁶.

Together with HPV vaccination, screening and treatment are crucial to cervical cancer elimination efforts. Nevertheless, such programs in LMICs face numerous challenges, which include organizational hurdles, limited resources, and restricted access to healthcare offerings⁷.

Symptoms:

Cervical cancer often presents with nonspecific signs and symptoms, making early detection difficult.⁸ Ordinary vaginal bleeding, pelvic pain, and pain during sex are not unusual symptoms; however, they can be attributed to other situations, main to delayed diagnosis and treatment⁹.

Diagnosis:

Diagnosing cervical cancer typically involves a mixture of screening tests, together with the Pap smear, visual inspection with acetic acid (VIA), and High Risk HPV DNA testing. These tests can discover bizarre cell growth and HPV infection, making allowance for early intervention and treatment.

Treatment:

Treatment for cervical cancer relies on the stage and severity of the disease. Surgical treatment, radiation therapy, and chemotherapy are not unusual treatment options. But getting admission to those treatments can be confined in LMICs, and ladies may additionally face full-size limitations to receiving timely and effective care¹⁰.

Prevention:

HPV vaccination is a relatively effective method in preventing HPV contamination and cervical cancer. Moreover, screening packages can detect extraordinary cell growth and HPV infection, allowing for early intervention and treatment. However, those applications require sizeable assets and infrastructure, which can be missing in LMICs. To improve cervical cancer prevention and management in LMICs, governments  can implement the national Immunization (HPV Vaccination) and national Screening  programme (HPV DNA testing) as a primary screening along with continuous public awareness and preventive health education about cervical cancer prevention, management and treatment.

Challenges: Although HPV vaccines have drastically reduced disease burden in high-income nations, their distribution in LMICs remains unevenranging from pilot programs to broader, yet often underfunded, national initiatives. Many LMICs rely on opportunistic screening with visual inspection with acetic acid (VIA) or conventional Pap smear approaches, which are often poorly implemented. Moreover, there is a critical lack of systems to ensure that women with positive screening results receive effective follow-up and treatment. Even when screening is in place, therapeutic services for pre-invasive lesions are often scarce or inaccessible. As highlighted in the literature, screening alone has no preventive value unless it is linked to effective treatment, reinforcing the need for integrated care pathways.

Author:

Dr. Sukanya Mehra, Ph.D.,  Cytogenetics Laboratory, Department of Zoology, Guru Nanak Dev University, Amritsar, India.

Edited by:

Dr. Mehreen Aftab, Ph.D., Amity Institute of Molecular Medicine & Stem Cell Research (AIMMSCR), Amity University, Uttar Pradesh, India.

References:

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