Cervical Cancer Screening in Low-Resource Settings

  • Ashrafun Nessa
  • Begum Rokeya Anwar
  • Shirin Akter Begum


Developed countries have reduced incidence and mortality of cervical cancer (CC) through cytology-based screening programs. Though a large number of the world’s population live in Low and Middle Income Countries (LMICs), cytology-based screening programs have been ineffective in them. Visual inspection with acetic acid (VIA) and the human papillomavirus (HPV) test have proven to be effective primary screening methods for CC screening in LMICs. However, the HPV test is too expensive for introduction in the screening program of many LMICs. VIA is therefore accepted as the method of screening in several LMICs, as it needs minimum infrastructure support and results are available immediately, so additional investigations/management can be carried out during the same visit.

In LMICs screening should be performed in women between 30 and 49 years and repeated every 5 years. In low-resource settings, a fewer-visit approach should be adopted, and screen-positive women should be managed with a “screen-and-treat” or “see-and-treat” strategy to ensure high compliance.

LMICs need to develop population-based organized CC screening program along with an electronic database for target age group. Strengthening various services within the existing health infrastructure and adequate supervision and monitoring are important factors to develop a successful screening program. Governments in such countries need to develop a pilot program to assess the feasibility of a screening method followed by gradual nationwide scale-up. Awareness should be created to develop health-seeking behavior among the community.


Cervical cancer screening Low-resource settings VIA HPV DNA test Screen-and-treat See-and-treat 



We are very much grateful to the International Agency for Research on Cancer (IARC), Lyon, France, including Dr. R. Sankaranarayanan and Dr. Partha Basu, and the World Health Organization for permitting us to use photographs, cancer statistics, and figures in the manuscript.


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Ashrafun Nessa
    • 1
  • Begum Rokeya Anwar
    • 2
  • Shirin Akter Begum
    • 1
  1. 1.Department of Obstetrics and GynaecologyBangabandhu Sheikh Mujib Medical University (BSMMU)DhakaBangladesh
  2. 2.Department of Gynaecological OncologyNational Institute of Cancer Research and HospitalDhakaBangladesh

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