Every woman—no matter where she lives—should have at least one good cervical cancer screen in her lifetime. Unfortunately, we are not even close to that.— Surendra S. Shastri, MD, MBBS
Earlier this month, ASCO issued a new global guideline on screening for cervical cancer.1 The guideline provides evidence-based recommendations for screening, follow-up of positive screening results, and treatment of women with cervical precancers in countries worldwide.
ASCO’s guideline recommends that all women in appropriate age groups—in low-resource, middle-resource and high-resource settings—be screened for cervical precancers. It specifically aims to establish consistent minimum standards for screening across countries, while accounting for wide variations in resource levels and health systems.
This is the first global screening guideline to incorporate the landmark 2013 finding that visual inspection with acetic acid (vinegar)—an inexpensive and simple method also known as VIA—can reduce cervical cancer mortality in some of the world’s poorest regions. However, it stresses that this method should only be used as a stepping stone to testing for human papillomavirus (HPV), which is the cause of virtually all cervical cancers.
‘One Good Cervical Screen at a Minimum’
“Every woman—no matter where she lives—should have at least one good cervical cancer screen in her lifetime. Unfortunately, we are not even close to that,” said Surendra S. Shastri, MD, MBBS, Co-Chair of the ASCO Expert Panel that developed the guideline and Professor of Preventive Oncology at Tata Memorial Center in Mumbai, India. “We hope that this guideline will bring us closer to the goal of providing high-quality preventive care to all women, regardless of their circumstances.”
The Society’s guideline was developed by a panel of experts from an array of international health and advocacy organizations and academic institutions. The panel outlined the minimum standards for cervical cancer screening in four distinct types of health-care settings: basic, limited, enhanced, and maximal. The tiers pertain not only to a country or region’s financial resources, but also to the strength of its health system, including personnel, infrastructure, and access to services.
The World Health Organization (WHO) last issued a global cervical cancer screening guideline in 2013. ASCO’s guideline builds upon WHO’s recommendations by providing a minimum set of standards across all countries based on their existing resources, and by accounting for the 2013 VIA study and other recent data.
Watch future issues of The ASCO Post for more on the recently published guideline recommendations.
This guideline has been endorsed by the International Gynecologic Cancer Society and the American Society for Colposcopy and Cervical Pathology. ■
1. Jeronimo J, Castle PE, Temin S, et al: Secondary prevention of cervical cancer: American Society of Clinical Oncology resource-stratified clinical practice guideline. J Global Oncol. October 12, 2016 (early release online).
Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid (VIA) may be used in the basic setting as a “stepping stone” that helps build health service capacity until HPV testing becomes available. Although cotesting with HPV and Papanicolaou...