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Cancer screening and prevention in low-resource settings

Nature Reviews Cancer volume 14, pages 822–829 (2014)Cite this article

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Abstract

Less-developed-region countries (LDCs) are seeing a rapid rise in cancer incidence owing to changing lifestyles, infections, environmental carcinogens and increasing longevity. LDCs have poor resources to deal with cancers, leading to high mortality rates. Investment in nationally implementable and sustainable cancer prevention and screening strategies would be more appropriate for LDCs. This Science and Society article outlines the burden of preventable cancers in selected LDCs and discusses evidence on cost-effective and widely implementable prevention and screening strategies.

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References

  1. Ferlay, J. et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. International Agency for Research on Cancer [Online] (2013).

    Google Scholar 

  2. Morrell, S., Taylor, R., Roder, D. & Dobson, A. Mammography screening and breast cancer mortality in Australia: an aggregate cohort study. J. Med. Screen 19, 26–34 (2012).

    Article  PubMed  Google Scholar 

  3. Wilkinson, J. E. Effect of mammography on breast cancer mortality. Am. Fam. Physician 84, 1225–1227 (2011).

    PubMed  Google Scholar 

  4. Magnus, M. C., Ping, M., Shen, M. M., Bourgeois, J. & Magnus, J. H. Effectiveness of mammography screening in reducing breast cancer mortality in women aged 39–49 years: a meta-analysis. J. Womens Health 20, 845–852 (2011).

    Article  Google Scholar 

  5. Tabar, L. et al. Mammography service screening and mortality in breast cancer patients: 20-year follow-up before and after introduction of screening. Lancet 361, 1405–1410 (2003).

    Article  PubMed  Google Scholar 

  6. Nygard, M. Screening for cervical cancer: when theory meets reality. BMC Cancer 11, 240 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sasieni, P., Castanon, A. & Cuzick, J. Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ 339, b2968 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  8. Adegoke, O., Kulasingam, S. & Virnig, B. Cervical cancer trends in the United States: a 35-year population-based analysis. Journal of women's health 21, 1031–1037 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shastri, S. S. et al. Effect of VIA screening by primary health workers: randomized controlled study in Mumbai, India. J. Natl Cancer Inst. 106, dju009 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Teguete, I. et al. Can visual cervical screening be sustained in routine health services? Experience from Mali, Africa. BJOG 119, 220–226 (2012).

    Article  CAS  PubMed  Google Scholar 

  11. Sankaranarayanan, R. et al. Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa. Int. J. Cancer 110, 907–913 (2004).

    Article  CAS  PubMed  Google Scholar 

  12. Lazcano-Ponce, E. C., Moss, S., Alonso de Ruiz, P., Salmeron Castro, J. & Hernandez Avila, M. Cervical cancer screening in developing countries: why is it ineffective? The case of Mexico. Arch. Med. Res. 30, 240–250 (1999).

    Article  CAS  PubMed  Google Scholar 

  13. Othman, N. H. & Rebolj, M. Challenges to cervical screening in a developing country: The case of Malaysia. Asian Pac. J. Cancer Prev. 10, 747–752 (2009).

    PubMed  Google Scholar 

  14. Goss, P. E. et al. Challenges to effective cancer control in China, India, and Russia. Lancet Oncol. 15, 489–538 (2014).

    Article  PubMed  Google Scholar 

  15. Wynder, E. L. & Stellman, S. D. Comparative epidemiology of tobacco-related cancers. Cancer Res. 37, 4608–4622 (1977).

    CAS  PubMed  Google Scholar 

  16. Moulin, J. J., Mur, J. M. & Cavelier, C. Comparative epidemiology, in Europe, of cancers related to tobacco (lung, larynx, pharynx, oral cavity). Bull. Cancer 72, 155–158 (1985).

    CAS  PubMed  Google Scholar 

  17. Restrepo, H. E., Correa, P., Haenszel, W., Brinton, L. A. & Franco, A. A case-control study of tobacco-related cancers in Colombia. Bull. Pan Am. Health Organ. 23, 405–413 (1989).

    CAS  PubMed  Google Scholar 

  18. Benhamou, S. Cancers related to tobacco smoking. Rev. Prat 43, 1214–1217 (1993).

    CAS  PubMed  Google Scholar 

  19. Gajalakshmi, C. K., Ravichandran, K. & Shanta, V. Tobacco-related cancers in Madras, India. Eur. J. Cancer Prev. 5, 63–68 (1996).

    CAS  PubMed  Google Scholar 

  20. World Health Organisation. GATS (Global Adult Tobacco Survey). WHO [online] (2014).

  21. Dikshit, R. et al. Cancer mortality in India: a nationally representative survey. Lancet 379, 1807–1816 (2012).

    Article  PubMed  Google Scholar 

  22. Borzekowski, D. L. & Cohen, J. E. International reach of tobacco marketing among young children. Pediatrics 132, e825–831 (2013).

    Article  PubMed  Google Scholar 

  23. Holford, T. R. et al. Tobacco control and the reduction in smoking-related premature deaths in the United States, 1964–2012. JAMA 311, 164–171 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Chaloupka, F. J., Yurekli, A. & Fong, G. T. Tobacco taxes as a tobacco control strategy. Tobacco Control 21, 172–180 (2012).

    Article  PubMed  Google Scholar 

  25. Hargreaves, K. et al. The social context of change in tobacco consumption following the introduction of 'smokefree' England legislation: a qualitative, longitudinal study. Social Sci. Med. 71, 459–466 (2010).

    Article  Google Scholar 

  26. International Agency for Research on Cancer (IARC). IARC Handbooks of Cancer Prevention, Tobacco Control, Volume 13: Evaluating the Effectiveness of Smoke-Free Policies. (WHO, 2009).

  27. Stallings-Smith, S., Zeka, A., Goodman, P., Kabir, Z. & Clancy, L. Reductions in cardiovascular, cerebrovascular, and respiratory mortality following the national irish smoking ban: interrupted time-series analysis. PLoS ONE 8, e62063 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Thavorn, K. & Chaiyakunapruk, N. A cost-effectiveness analysis of a community pharmacist-based smoking cessation programme in Thailand. Tobacco Control 17, 177–182 (2008).

    Article  CAS  PubMed  Google Scholar 

  29. World Health Organisation. WHO Framework Convention on Tobacco Control. WHO [online] (2014).

  30. World Health Organisation. Parties to the WHO Framework Convention on Tobacco Control. WHO [online] (2014).

  31. Jemal, A. et al. Global cancer statistics. CA Cancer J. Clin. 61, 69–90 (2011).

    Article  PubMed  Google Scholar 

  32. Kamangar, F., Dores, G. M. & Anderson, W. F. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J. Clin. Oncol. 24, 2137–2150 (2006).

    Article  PubMed  Google Scholar 

  33. Yankaskas, B. C. et al. Performance of first mammography examination in women younger than 40 years. J. Natl Cancer Inst. 102, 692–701 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  34. Haukka, J., Byrnes, G., Boniol, M. & Autier, P. Trends in breast cancer mortality in Sweden before and after implementation of mammography screening. PLoS ONE 6, e22422 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Gotzsche, P. C. Relation between breast cancer mortality and screening effectiveness: systematic review of the mammography trials. Dan Med. Bull. 58, A4246 (2011).

    PubMed  Google Scholar 

  36. Biller-Andorno, N. & Juni, P. Abolishing mammography screening programs? A view from the Swiss Medical Board. N. Engl. J. Med. 370, 1965–1967 (2014).

    Article  PubMed  Google Scholar 

  37. Kapp, J. M., Walker, R., Haneuse, S., Buist, D. S. & Yankaskas, B. C. Are there racial/ethnic disparities among women younger than 40 undergoing mammography? Breast Cancer Res. Treat. 124, 213–222 (2010).

    Article  Google Scholar 

  38. Harford, J. B. Breast-cancer early detection in low-income and middle-income countries: do what you can versus one size fits all. Lancet Oncol. 12, 306–312 (2011).

    Article  PubMed  Google Scholar 

  39. Semiglazov, V. F. et al. Results of a prospective randomized investigation [Russia (St. Petersburg)/WHO] to evaluate the significance of self-examination for the early detection of breast cancer. Vopr Onkol 49, 434–441 (2003).

    CAS  PubMed  Google Scholar 

  40. Thomas, D. B. et al. Randomized trial of breast self-examination in Shanghai: final results. J. Natl Cancer Inst. 94, 1445–1457 (2002).

    Article  PubMed  Google Scholar 

  41. Miller, A. B. et al. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial. BMJ 348, g366 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Pisani, P. et al. Outcome of screening by clinical examination of the breast in a trial in the Philippines. Int. J. Cancer 118, 149–154 (2006).

    Article  CAS  PubMed  Google Scholar 

  43. Dinshaw, K. et al. Determinants of compliance in a cluster randomised controlled trial on screening of breast and cervix cancer in Mumbai, India. 1. Compliance to screening. Oncology 73, 145–153 (2007).

    Article  PubMed  Google Scholar 

  44. Grosse Frie, K. et al. Determinants of participation in a breast cancer screening trial in Trivandrum district, India. Asian Pac. J. Cancer Prev. 14, 7301–7307 (2013).

    Article  PubMed  Google Scholar 

  45. Mittra, I. et al. A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening. International journal of cancer. J. Int. Cancer 126, 976–984 (2010).

    CAS  Google Scholar 

  46. Sankaranarayanan, R. et al. Clinical breast examination: preliminary results from a cluster randomized controlled trial in India. J. Natl Cancer Institute 103, 1476–1480 (2011).

    Article  Google Scholar 

  47. Denewer, A. et al. Cost-effectiveness of clinical breast assessment-based screening in rural Egypt. World J. Surg. 34, 2204–2210 (2010).

    Article  PubMed  Google Scholar 

  48. Okonkwo, Q. L., Draisma, G., der Kinderen, A., Brown, M. L. & de Koning, H. J. Breast cancer screening policies in developing countries: a cost-effectiveness analysis for India. J. Natl Cancer Inst. 100, 1290–1300 (2008).

    Article  PubMed  Google Scholar 

  49. de Sanjose, S. et al. Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect. Dis. 7, 453–459 (2007).

    Article  PubMed  Google Scholar 

  50. Flores, Y. et al. Improving cervical cancer screening in Mexico: results from the Morelos HPV Study. Salud Publ. Mexico 45, S388–S398 (2003).

    Article  Google Scholar 

  51. Markowitz, L. E. et al. Human papillomavirus vaccine introduction—the first five years. Vaccine 30 (Suppl. 5), F139–148 (2012).

    Article  PubMed  Google Scholar 

  52. Sankaranarayanan, R. et al. HPV screening for cervical cancer in rural India. N. Engl. J. Med. 360, 1385–1394 (2009).

    Article  CAS  PubMed  Google Scholar 

  53. Akamatsu, S., Kodama, S., Himeji, Y., Ikuta, N. & Shimagaki, N. A comparison of liquid-based cytology with conventional cytology in cervical cancer screening. Acta Cytol. 56, 370–374 (2012).

    Article  PubMed  Google Scholar 

  54. Siebers, A. G. et al. Comparison of liquid-based cytology with conventional cytology for detection of cervical cancer precursors: a randomized controlled trial. JAMA 302, 1757–1764 (2009).

    Article  CAS  PubMed  Google Scholar 

  55. Tsonev, A., Ivanov, S. & Kovachev, E. Comparison of conventional PAP smear with liquid based cytology method (LBC). Akusherstvo i ginekologiia 51, 20–24 (2012).

    CAS  PubMed  Google Scholar 

  56. Laiwejpithaya, S. et al. Comparison between Siriraj liquid-based and conventional cytology for detection of abnormal cervicovaginal smears: a split-sample study. Asian Pac. J. Cancer Prev. 9, 575–580 (2008).

    PubMed  Google Scholar 

  57. Sankaranarayanan, R. et al. Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial. Lancet 370, 398–406 (2007).

    Article  PubMed  Google Scholar 

  58. Tamil Nadu Health Systems Project. Screening for Cervical Cancer and Breast Cancer. TNHSP [online] (2014).

  59. Nessa, A. et al. Role of print and audiovisual media in cervical cancer prevention in Bangladesh. Asian Pac. J. Cancer Prev. 14, 3131–3137 (2013).

    Article  PubMed  Google Scholar 

  60. Untiet, S. et al. HPV self-sampling as primary screening test in sub-Saharan Africa: Implication for a triaging strategy. Int. J. Cancer 135, 1911–1917 (2014).

    Article  CAS  PubMed  Google Scholar 

  61. [no authors listed] HPV Test Recommended as Primary Screening Tool. Cancer Discovery 4, OF6 (2014).

  62. Huang, J. et al. MGB-based one-step multiplex real-time PCR method for rapid detection of HPV. Cancer Biomark. 12, 107–113 (2012).

    Article  CAS  PubMed  Google Scholar 

  63. Zhao, J. et al. Clinical performance characteristics of the Cervista HPV HR test kit in cervical cancer screening in China. J. Lower Genital Tract Dis. 16, 358–363 (2012).

    Article  Google Scholar 

  64. Ogilvie, G. S. et al. Primary cervical cancer screening with HPV testing compared with liquid-based cytology: results of round 1 of a randomised controlled trial — the HPV FOCAL Study. Br. J. Cancer 107, 1917–1924 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Arbyn, M., Walker, A. & Meijer, C. J. HPV-based cervical-cancer screening in China. Lancet Oncol. 11, 1112–1113 (2010).

    Article  PubMed  Google Scholar 

  66. Qiao, Y. L. et al. A new HPV-DNA test for cervical-cancer screening in developing regions: a cross-sectional study of clinical accuracy in rural China. Lancet Oncol. 9, 929–936 (2008).

    Article  PubMed  Google Scholar 

  67. Hopkins, T. G. & Wood, N. Female human papillomavirus (HPV) vaccination: global uptake and the impact of attitudes. Vaccine 31, 1673–1679 (2013).

    Article  PubMed  Google Scholar 

  68. Tracy, J. K., Schluterman, N. H., Greene, C., Sow, S. O. & Gaff, H. D. Planning for human papillomavirus (HPV) vaccination in sub-Saharan Africa: A modeling-based approach. Vaccine 32, 3316–3322 (2014).

    Article  PubMed  Google Scholar 

  69. Levin, A., Wang, S. A., Levin, C., Tsu, V. & Hutubessy, R. Costs of introducing and delivering H.P.V. vaccines in low and lower middle income countries: inputs for GAVI policy on introduction grant support to countries. PloS one 9, e101114 (2014).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  70. Gavi. Human papillomavirus vaccine support. [online] (2014).

  71. Pandhi, D. & Sonthalia, S. Human papilloma virus vaccines: Current scenario. Indian J. Sexually Transmitted Diseases 32, 75–85 (2011).

    Article  Google Scholar 

  72. Gupta, S., Kerkar, R. A., Dikshit, R. & Badwe, R. A. Is human papillomavirus vaccination likely to be a useful strategy in India? South Asian J. Cancer 2, 193–197 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  73. Naud, P. S. et al. Sustained efficacy, immunogenicity, and safety of the HPV-16/18 AS04-adjuvanted vaccine: Final analysis of a long-term follow-up study up to 9.4 years post-vaccination. Hum. Vaccin. Immunother. http://dx.doi.org/10.4161/hv.29532 (2014).

  74. Konno, R. et al. Efficacy of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical intraepithelial neoplasia and cervical infection in young Japanese women: Open follow-up of a randomized clinical trial up to 4 years post-vaccination. Hum. Vaccin. Immunother. 10, 1781–1794 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  75. Descamps, D. et al. Safety of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine for cervical cancer prevention: a pooled analysis of 11 clinical trials. Hum. Vaccin 5, 332–340 (2009).

    Article  PubMed  Google Scholar 

  76. Chao, C. et al. Surveillance of autoimmune conditions following routine use of quadrivalent human papillomavirus vaccine. J. Intern. Med. 271, 193–203 (2012).

    Article  CAS  PubMed  Google Scholar 

  77. Arnheim-Dahlstrom, L., Pasternak, B., Svanstrom, H., Sparen, P. & Hviid, A. Autoimmune, neurological, and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: cohort study. BMJ 347, f5906 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  78. Dobson, S. R. et al. Immunogenicity of 2 doses of HPV vaccine in younger adolescents versus 3 doses in young women: a randomized clinical trial. JAMA 309, 1793–1802 (2013).

    Article  CAS  PubMed  Google Scholar 

  79. Romanowski, B. et al. Immune response to the HPV-16/18 AS04-adjuvanted vaccine administered as a 2-dose or 3-dose schedule up to 4 years after vaccination: Results from a randomized study. Hum. vaccin. immunother. 10, 1155–1165 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  80. [no authors listed] World policy-makers cite UBC-CFRI research in approving fewer HPV vaccine doses. University of British Columbia [online] (2014).

  81. Spencer, A. M., Roberts, S. A., Brabin, L., Patnick, J. & Verma, A. Sociodemographic factors predicting mother's cervical screening and daughter's HPV vaccination uptake. J. Epidemiol. Commun. Health 68, 571–577 (2014).

    Article  Google Scholar 

  82. Parikh, S. & Hyman, D. Hepatocellular cancer: a guide for the internist. Am. J. Med. 120, 194–202 (2007).

    Article  PubMed  Google Scholar 

  83. Venook, A. P., Papandreou, C., Furuse, J. & de Guevara, L. L. The incidence and epidemiology of hepatocellular carcinoma: a global and regional perspective. Oncologist 15 (Suppl. 4), 5–13 (2010).

    Article  PubMed  Google Scholar 

  84. Nordenstedt, H., White, D. L. & El-Serag, H. B. The changing pattern of epidemiology in hepatocellular carcinoma. Dig. Liver Dis. 42 (Suppl. 3), S206–214 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  85. Zhang, B. H., Yang, B. H. & Tang, Z. Y. Randomized controlled trial of screening for hepatocellular carcinoma. J. Cancer Res. Clin. Oncol. 130, 417–422 (2004).

    PubMed  Google Scholar 

  86. Chen, J. G. et al. Screening for liver cancer: results of a randomised controlled trial in Qidong, China. J. Med. Screen 10, 204–209 (2003).

    Article  PubMed  Google Scholar 

  87. Sherman, M., Bruix, J., Porayko, M. & Tran, T. Screening for hepatocellular carcinoma: the rationale for the American Association for the Study of Liver Diseases recommendations. Hepatology 56, 793–796 (2012).

    Article  PubMed  Google Scholar 

  88. Ferenci, P. et al. World Gastroenterology Organisation Guideline. Hepatocellular carcinoma (HCC): a global perspective. J. Gastrointestin Liver Dis. 19, 311–317 (2010).

    PubMed  Google Scholar 

  89. Omata, M. et al. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int. 4, 439–474 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  90. Lederle, F. A. & Pocha, C. Screening for liver cancer: the rush to judgment. Ann. Intern. Med. 156, 387–389 (2012).

    Article  PubMed  Google Scholar 

  91. Franco, E. et al. Hepatitis B: Epidemiology and prevention in developing countries. World J. Hepatol. 4, 74–80 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  92. Goldstein, S. Global routine vaccination coverage, 2010. MMWR 60, 1520–1522 (2011).

    Google Scholar 

  93. Chen, C. J., You, S. L., Lin, L. H., Hsu, W. L. & Yang, Y. W. Cancer epidemiology and control in Taiwan: a brief review. Jpn J. Clin. Oncol. 32, S66–S81 (2002).

    Article  PubMed  Google Scholar 

  94. Lee, C. L., Hsieh, K. S. & Ko, Y. C. Trends in the incidence of hepatocellular carcinoma in boys and girls in Taiwan after large-scale hepatitis B vaccination. Cancer Epidemiol. Biomarkers Prev. 12, 57–59 (2003).

    CAS  PubMed  Google Scholar 

  95. Kirk, G. D., Bah, E. & Montesano, R. Molecular epidemiology of human liver cancer: insights into etiology, pathogenesis and prevention from The Gambia, West Africa. Carcinogenesis 27, 2070–2082 (2006).

    Article  CAS  PubMed  Google Scholar 

  96. The General Assembly. Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. [online] WHO (2014).

  97. Mahal, A., Karan, A., Fan, V. Y. & Engelgau, M. The economic burden of cancers on Indian households. PloS one 8, e71853 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. McMahon, P. M. et al. Comparing benefits from many possible computed tomography lung cancer screening programs: extrapolating from the national lung screening trial using comparative modeling. PLoS ONE 9, e99978 (2014).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  99. Patz, E. F. Jr et al. Overdiagnosis in low-dose computed tomography screening for lung cancer. JAMA Intern. Med. 174, 269–274 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  100. Mizoue, T. et al. Prospective study of screening for stomach cancer in Japan. Int. J. Cancer 106, 103–107 (2003).

    Article  CAS  PubMed  Google Scholar 

  101. Leung, W. K. et al. Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol. 9, 279–287 (2008).

    Article  PubMed  Google Scholar 

  102. Choi, Y. S. et al. Colonoscopy screening for individuals aged 40–49 years with a family history of stomach cancer in Korea. Int. J. Colorectal Dis. 25, 443–447 (2010).

    Article  PubMed  Google Scholar 

  103. Sankaranarayanan, R., Gaffikin, L., Jacob, M., Sellors, J. & Robles, S. A critical assessment of screening methods for cervical neoplasia. Int. J. Gynaecol. Obstet. 89 (Suppl. 2), S4–S12 (2005).

    Article  PubMed  Google Scholar 

  104. Ying, H., Jing, F., Fanghui, Z., Youlin, Q. & Yali, H. High-risk HPV nucleic acid detection kit-the careHPV test -a new detection method for screening. Sci. Rep. 4, 4704 (2014).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  105. Bansil, P. et al. Acceptability of self-collection sampling for HPV-DNA testing in low-resource settings: a mixed methods approach. BMC Public Health 14, 596 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  106. Cervical screening. NHS [online] (2014).

  107. Segi, M. Cancer mortality for selected sites in 24 countries (1950-57). (Tohoku University of Medicine, 1960).

    Google Scholar 

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Authors and Affiliations

  1. Albert Einstein College of Medicine, Hematology–Oncology, 1300 Morris Park Avenue, Bronx, New York, 10461, New York, USA

    Aditi Shastri

  2. Tata Memorial Centre, Preventive Oncology, Ernest Borges Road, Parel, Mumbai, 400012, India

    Surendra Srinivas Shastri

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  1. Aditi Shastri
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Correspondence to Surendra Srinivas Shastri.

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Glossary

α-fetoprotein

(AFP). AFP is a protein found in the blood. It is produced by the liver of the fetus and its level steadily decreases after birth. Raised AFP levels in the blood are indicators of the presence of several diseases, including hepatocellular carcinoma.

Breast self-examination

(BSE). Both breasts are periodically (usually monthly) examined by the subject herself in a systematic manner.

Global Alliance for Vaccines and Immunization

(GAVI). A public–private global health partnership that is committed to increasing access to immunization in poor countries. GAVI has been negotiating with human papillomavirus (HPV) vaccine manufacturers to provide the vaccine to less-developed-region countries (LDCs) at very low costs.

Less-developed-region countries

(LDCs; as defined by the United Nations Population Division, Department of Economic and Social Affairs definition, 2012 revision). All regions of Africa, Asia (excluding Japan), Latin America and the Caribbean, Melanesia, Micronesia and Polynesia.

Level-1 evidence of efficacy

Level-1 A evidence is derived from meta-analysis of randomized controlled trials, and Level-1 B evidence is derived from at least one randomized controlled trial. Grade A recommendations for medical practice are all based on Level 1 evidence.

More-developed-region countries

(MDCs; as defined by the United Nations Population Division, Department of Economic and Social Affairs definition, 2012 revision). All regions of Europe, North America, Australia, New Zealand and Japan.

Opportunistic screening

Also known as case-finding, this is a form of screening that is restricted to patients who consult a health practitioner for some other purpose.

Physical breast examination

(PBE). Both breasts and axillae are thoroughly examined in a systematic manner by a trained health care provider.

Prevalence

The number of persons in a defined population who have been diagnosed with the disease and who are still alive at the end of a given year.

Primary health workers

(PHWs). In LDCs, PHWs are usually state health services employees with some high school education and training in basic management of maternal and child health services and simple interventions for commonly occurring diseases in the community.

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Shastri, A., Shastri, S. Cancer screening and prevention in low-resource settings. Nat Rev Cancer 14, 822–829 (2014). https://doi.org/10.1038/nrc3859

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