Cervical cancer screening and practice in low resource countries: Nigeria as a case study
Cervical cancer is the most common female genital tract malignancy in Nigeria and majority of the patients present with advanced disease. It is a preventable cancer as there are well‑defined treatable premalignant phases. The objective of the study is to review the burden of cervical cancer, its screening modalities, and practice of screening and treatment in low resource countries with emphasis on Nigeria. This is a review involving internet and literature search. While developed countries have recorded significant reduction in the incidence of cervical cancer owing to organizedscreening programs, treatment of premalignant cervical lesions, and follow‑up of treated cases, developing countries including Nigeria are yet to optimally utilize screening services due to lack of organized population‑based screening programs with only pockets of screening services which are at best opportunistic. This has not reduced the incidence of cancer because only a fraction of the target population is covered. Apart from this, loss to follow‑up is rampant. The level of awareness of cervical cancer and its preventive strategies are low among the population and policymakers in Nigeria. There is no organized screening program, and the few services available are only opportunistic with little or no impact. Development of cervical cancer screening policy and institution of organized screening program targeted at covering ≥80% of population at risk is fundamental. There is also a need for widespread education of the populace on the burden of cervical cancer and the public health importance of the disease using the mass media, counseling at antenatal clinics, and the involvement of men will contribute immensely to reduction in the incidence of cervical cancer. Decentralization of services by incorporation of cervical screening and treatment in primary health care programs will ensure adequate rural‑urban coverage.
Keywords: Cervical cancer screening; human papillomavirus, low resource countries; Nigeria; premalignant disease