Women in developing countries face an increased risk of cervical cancer because they are not regularly screened for the disease, a study has found.
Though women in low-income countries are more likely to be exposed to risk factors like smoking and unsafe sex, just 19 per cent of women in the developing world have been screened — compared to 63 per cent in developed countries.
The researchers analysed WHO surveys from 57 countries, conducted in 2002.
They found that in Bangladesh, Ethiopia and Myanmar, less than one per cent of women had undergone any form of screening for cervical cancer. And in Bangladesh, Ethiopia and Malawi, 90 per cent of women had never had a pelvic examination (inspection of the female organs), yet alone any further testing.
Emmanuela Gakidou, an associate professor at the University of Washington, Seattle and an author on the paper, told SciDev.Net that the study highlighted large wealth-related inequalities in access to screening.
These inequalities were further apparent within individual countries, with poor and older women — at the highest risk of developing the disease — the least likely to be screened.
"There is an urgent need to improve cervical cancer screening programmes worldwide while, at the same time, keeping track of the quality and the frequency of screening and control efforts, especially for disadvantaged women," she says.
Gakidou says investing in cost-effective screening programmes would reduce the burden of disease, though more novel strategies may be needed for different countries.
Lynette Denny, from the Gynaecology Oncology Unit at the University of Cape Town in South Africa, said the study provided evidence that cervical cancer is a disease of inequity in terms of access to healthcare resources.
Prevention programmes compete with other pressing health needs in poor countries like maternal mortality, tuberculosis, malaria and HIV/AIDS, says Denny.
"In Africa there is widespread poverty, endemic civil strife and environmental instability. These, and many other, factors make setting up screening programmes very difficult. Hence the need to develop alternative strategies to the Pap smear — the standard test for cervical cancer — such as visual inspection and possibly vaccination in the future."
The United States is spending around US$8 billion to maintain its effective cervical cancer screening programme.
"For countries that spend less than US$10 per year per capita [on healthcare], these programmes are prohibitively expensive," says Denny.
PLoS Medicine doi10.1371/journal.pmed.0050132 (2008)