Coverage of Cervical Cancer Screening in 57 Countries: Low Average Levels and Large Inequalities
Emmanuela Gakidou, Stella Nordhagen, and Ziad Obermeyer are at the Institute for Health Metrics and Evaluation at the
PLoS Med June 2008 - 5(6): e132
Available online at: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050132
“….Effective coverage rates for cervical cancer screening services are very low outside of developed countries, and women at the highest risk of developing cervical cancer are among the least likely to be screened. Coverage rates decline with advancing age, when cervical cancer incidence rates are the highest. Poor women, who likely have higher exposure to known cervical cancer biological risk factors such as smoking and unsafe sex [62], also show much lower coverage rates.
Improving the effective coverage of cervical cancer screening or developing alternative ways to decrease cervical cancer mortality worldwide would have a considerable impact on decreasing the disease's burden as well as overall health inequalities. No one strategy will work everywhere, making it important to consider multiple strategies across—and likely within—countries….”
Summary Points
- The large declines in cervical cancer mortality in developed countries have been attributed to widespread screening, but it is unclear whether this success can be replicated in the developing world.
- It is generally assumed that screening coverage in the developing world is low; in this paper we substantiate this claim with evidence from 57 countries, thus contributing to the evidence base for formulation of effective policies.
- Our analysis of population-based surveys indicates that coverage of cervical cancer screening in developing countries is on average 19%, compared to 63% in developed countries, and ranges from 1% in
- Older and poor women, who are at the highest risk of developing cervical cancer, are least likely to be screened.
- Strategies for improving cervical cancer prevention must be adapted to meet the specific needs of individual countries: expanded screening may be a viable option where sufficient infrastructure and health system access exists, but novel strategies need to be considered in other settings.
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