Large-scale study in China shows promise for cervical cancer screening in resource-limited regions

Cervical cancer continues to pose a significant health burden, especially in low- and middle-income countries, where approximately 90% of cases occur. In China alone, the disease accounts for an estimated 150,700 new cases and 55,700 deaths annually. The World Health Organization (WHO) has emphasised the importance of screening as a vital intervention in the quest to eliminate cervical cancer, proposing a target of screening 70% of women with high-quality tests.

However, implementing effective screening programs in resource-constrained settings has been challenging. Traditional cytology-based screening faces obstacles such as limited availability of experts and high costs. In response, the WHO recommended human papillomavirus (HPV) DNA–based tests as a preferred primary screening method due to their accuracy and feasibility, even in low-resource areas.

To address triage among HPV-positive individuals, the WHO suggested visual inspection with acetic acid as an alternative method, particularly in regions with limited resources. However, evidence supporting its performance on a large scale has been limited.

In a study conducted in Ordos City, China, researchers evaluated the effectiveness of HPV testing as the primary screening method followed by visual inspection with acetic acid and Lugol iodine for triage. Despite facing challenges in accessing healthcare due to uneven development and disparities in medical resource distribution, the city initiated a government-led cervical cancer screening program in 2009.

Over five years, the program aimed to screen 60% of women aged 35 to 64, covering approximately 203,400 women. The study, which followed the STROBE reporting guideline, included 187,863 women aged 35 to 64. Among them, 24,070 tested positive for HPV, resulting in an overall HPV positivity rate of 12.8%.

Visual inspection was conducted in parallel with HPV testing, reducing colposcopy referral rates to 18.3% among HPV-positive women. The compliance rate for immediate colposcopy referrals was high at 95.0% for suspected cancer cases based on visual inspection. Detection rates for cervical intraepithelial neoplasia 2+ (CIN2+) and CIN3+ were 2.8% and 1.9%, respectively.

The study demonstrated that integrating HPV testing, visual inspection, and colposcopy in a single visit effectively reduced loss to follow-up and detected precancerous lesions. The findings provide valuable insights for decision-makers in similar resource-constrained settings considering cervical cancer screening programs.

However, the study also faced limitations, including suboptimal colposcopy compliance rates, highlighting the need for further investigation into improving screening program participation.

In conclusion, the study showcases a promising approach to cervical cancer screening in resource-limited regions, offering hope for reducing the burden of this disease worldwide.