Cervical Cancer Screening Cost-Effective in Developing Countries

Cervical cancer accounts for the deaths of approximately 200,000 women annually in developing countries. It ranks as the third most common cancer overall and is the primary cause of death from cancer among women, according to the National Cervical Cancer Coalition.

These statistics have been dismaying to health care professionals. Screening programs using cytology have dramatically reduced the rate of cervical cancer in the United States and European and other developed countries. However, for many underdeveloped countries, such programs are impossible to implement because of a lack of resources.

N Engl J Med

A study conducted by Sue J. Goldie, MD, MPH, of the Department of Health Policy and Management, Harvard School of Public Health, Boston, and colleagues (. 2005;353:2158-2168) used computer-based models to determine which alternative cervical cancer screening methods would be the most clinically successful and cost-effective in developing countries, including India, Kenya, Peru, South Africa, and Thailand (Table).

Data were combined to approximate the age-specific frequency and mortality rates for cancer and the efficacy of screening for and treatment of precancerous lesions.

The most clinically beneficial and cost-effective methods were those that improved the connection between screening and treatment, by reducing the number of visits or by enhancing follow-up, and that depended less on laboratory infrastructure than did cytology-based screening.

Results showed that the lifetime risk of cervical cancer in women aged approximately 35 years could be reduced by 25% to 36% with a 1- or 2-visit visual inspection of the cervix with acetic acid or human papillomavirus (HPV) DNA testing, at a cost of <$500 per life saved. With 2 lifetime screenings, risk of cervical cancer could be reduced by about 40% at a cost for 1 year of life saved that was below each country&#8217;s per capita gross domestic product, which is regarded as a &#8220;very cost-effective result.&#8221;

With maximized follow-up, HPV DNA testing was the most successful approach, followed closely by visual inspection, and then cytologic examination. The least successful approaches were 2-visit and 3-visit cytologic examination and the combination of 2-visit visual inspection and HPV DNA testing.

The researchers concluded that policy implications for these countries were comparable once their relative resources were taken into account. They also noted that using these strategies could &#8220;lower the global incidence of cervical cancer by as much as 50%.&#8221;