Preventing cervical cancer in low‐resource settings: Building a case for the possible

Historical progress in the reduction of morbidity and mortality from cervical cancer has been attributed to systematic screening programs in wealthy countries—an option that has long seemed out of reach for poorer countries. Recent developments suggest, however, that there is new hope for bringing cervical cancer under control, even in countries with limited financial and infrastructural resources. References to cervical cancer appear as early as the fifth century BC, in Greek and Hindu texts, but more complete descriptions of the disease and its treatment first appear in various medical texts in the 19th century [1]. In 1900, Cullen introduced the concept that precursor lesions were harbingers of cancer of the cervix [2]. Over the course of the next 60 years, further investigation led to a description of the natural history of the disease and to our current understanding of its infectious nature and its slow growth, both of which supported the evolution of prevention strategies. Cytologic methods of screening for cervical cancer and its precursors have become the mainstay of population-based prevention programs, resulting in substantial reduction of disease in countries such as Canada and Finland, where mass screening is systematic, rather than opportunistic [3,4]. In today’s world, cervical cancer is primarily a disease found in low-income countries. Of the nearly 500,000 new cases that occur annually, 83% are in the developing world, as are 85% of the 274,000 deaths associated with cervical cancer [5]. This disease burden is primarily the result of weak national health care infrastructures that cannot establish or sustain well-organized screening programs using the comprehensive, multi-visit,