Cervical cancer burden, status of implementation and challenges of cervical cancer screening in Association of Southeast Asian Nations (ASEAN) countries.

Multiple barriers impede the transformation of evidence-based research into implementation of cervical cancer screening in ASEAN countries. This review is the first of its kind to show the disease burden of cervical cancer, progress till date to implement screening and corresponding challenges, and propose tailored solutions to promote cervical cancer prevention in ASEAN. In 2020, approximately 69 000 cervical cancer cases and 38 000 deaths happened in ASEAN, and more than 44% and 63% increases on new cases and deaths are expected in 2040. Only four countries have initiated population-based cervical cancer screening programs, but the participation rate is less than 50% in some countries and even lower than 10% in Myanmar and Indonesia. Inequity and unavailability in service delivery, lack of knowledge and awareness, limited follow-up and treatment capacity, and funding sustainability affect successful scale-up of cervical cancer screening most in ASEAN. Implementing HPV detection-based primary screening, appropriate management of screen-positives, enhancing health education, integrating health services can accelerate reduction of cervical cancer burden in ASEAN. Achieving high screening coverage and high treatment compliance will help ASEAN countries remain aligned to cervical cancer elimination strategies.

Asia oceania guidelines for the implementation of programs for cervical cancer prevention and control.

This paper aims to provide evidence-based recommendations for health professionals, to develop a comprehensive cervical cancer program for a clinic, a community, or a country. Ensuring access to healthcare is the responsibility of all societies, and the Asia Oceania Research Organisation in Genital Infections and Neoplasia (AOGIN) is committed to working collaboratively with governments and health professionals to facilitate prevention programs, to protect girls and women from cervical cancer, a disease that globally affects 500,000 and kills nearly 300,000 women annually, just over half of whom are in the Asia Oceania region. We share the vision that a comprehensive program of vaccination, screening, and treatment should be made accessible to all girls and women in the world. The primary purpose of these guidelines is to provide information on scientific evidence on the different modalities and approaches of cervical cancer prevention programs, for high resource and low resource settings. The secondary purpose is to provide an overview of the current situation of cervical cancer control and prevention in various Asian Oceania countries: their views of an ideal program, identified obstacles, and suggestions to overcome them are discussed.

Screening of cervical neoplasia by using pap smear with speculoscopy compared with pap smear alone.

OBJECTIVE: The objective was to compare the sensitivity and specificity of Pap smear plus speculoscopy with Pap smear alone. MATERIAL AND METHOD: The study was conducted in the Gynecology Clinic, Rajavithi hospital, Thailand between February 1st and July 31st 2003. Women who made a request for cervical screening underwent a Pap smear, speculoscopy and colposcopy. Colposcopically directed biopsies were obtained from women who had a positive colposcopy. Analytical methods were applied. RESULTS: Of 257 women recruited to the study, Pap smear plus speculoscopy could increase sensitivity from 6.67% with Pap smear alone and to 33.33% when Pap smear plus speculoscopy is used. The false negative rate was reduced from 93.33% with Pap alone and to 66.67% with Pap smear plus speculoscopy. In using Pap smear alone compared with combination of two tests, the specificity decreased from 97.52% to 77.68% and false positive rate increased from 2.48% to 22.31%, respectively. CONCLUSION: Adding speculoscopy to the Pap smear is able to significantly increase the sensitivity of the cervical screening. It also reduces the 'false negative" result. However, as expected, the specificity slightly decreases, due to the false positive from speculoscopy itself. One solution is to defer colposcopy for 6 months and to perform colposcopy only if either Pap smear or speculoscopy is positive.