Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities

Summary Points * The large declines in cervical cancer mortality in developed countries have been attributed to widespread screening, but it is unclear whether this success can be replicated in the developing world. * It is generally assumed that screening coverage in the developing world is low; in this paper we substantiate this claim with evidence from 57 countries, thus contributing to the evidence base for formulation of effective policies. * Our analysis of population-based surveys indicates that coverage of cervical cancer screening in developing countries is on average 19%, compared to 63% in developed countries, and ranges from 1% in Bangladesh to 73% in Brazil. * Older and poor women, who are at the highest risk of developing cervical cancer, are least likely to be screened. * Strategies for improving cervical cancer prevention must be adapted to meet the specific needs of individual countries: expanded screening may be a viable option where sufficient infrastructure and health system access exists, but novel strategies need to be considered in other settings. In many countries, a large proportion of women have had pelvic examinations, but the exam was not accompanied by laboratory tests or was not done in the three years preceding the survey.\n Also, while it is likely that women would remember a pelvic exam, our estimates of effective coverage are limited by the ability of women to report whether a laboratory test (i.e., a Pap smear) was performed in the context of the pelvic exam. Since it is possible that a number of women were not informed, did not understand, or did not report this test, our numbers may represent a low estimate of effective coverage.