Title: Cervical dysplasia treatment: key issues for developing countries.

POPLINE Document Number: 121029

Author(s):

Bishop A
Sherris J
Tsu VD
Kilbourne-Brook M

Source citation:

BULLETIN OF THE PAN AMERICAN HEALTH ORGANIZATION, 1996 Dec;30(4):378-86.

Abstract:

Financial, technical, and logistical factors have impeded the establishment of effective cervical cancer control programs in many developing countries. Efforts are now underway to strengthen cytology services and identify simple, inexpensive, alternative screening strategies that will improve early detection of cervical intraepithelial neoplasia (CIN). As part of this effort, the Program for Appropriate Technology in Health (PATH) surveyed the CIN treatment practices and preferences of 110 health practitioners from 33 developing countries. The survey revealed widespread reliance on invasive inpatient procedures such as cone biopsy and hysterectomy and a tendency to treat all preinvasive CIN, rather than only high-grade or severe CIN. Simple, low-cost, effective (80-95%) outpatient procedures such as cryotherapy and the loop electrosurgical excision procedure (LEEP) were selected more widely in Asia, the Caribbean, and Latin America than in Africa, but remained underutilized relative to inpatient treatments. In many settings, colposcopes and other basic equipment were not available. Respondents identified hysterectomy, cone biopsy, and LEEP as the most effective treatments of severe dysplasia. Overall, these findings suggest a need for more efficient use of scarce medical resources. Cryotherapy and LEEP, combined with proper follow-up, are particularly appropriate for developing countries in cases where invasive cancer and endocervical involvement have been ruled out.

Keywords:

Developing Countries
Surveys
Cervical Cancer
Cervical Effects
Cytology
Screening
Treatment
Prevention and Control
Sampling Studies
Studies
Research Methodology
Cancer
Neoplasms
Diseases
Cervix
Uterus
Genitalia, Female
Genitalia
Urogenital System
Physiology
Biology
Examinations and Diagnoses