Addressing Global Disparities in Cervical Cancer Burden: A Narrative Review of Emerging Strategies

Purpose of ReviewCervical cancer burden is disproportionately higher in low to middle income countries, especially in countries with a high human immunodeficiency virus (HIV) burden. This review investigates barriers to implementation and assesses current progress in cervical cancer screening in lower resource settings by reviewing technologies and strategies that have already been implemented in low to middle income countries.Recent FindingsSeveral novel innovations embrace the recent World Health Organization (WHO) update to screening guidelines that recommends a "screen and treat" approach rather than a "screen, triage and treat" approach. Innovations include human papillomavirus (HPV) self-sampling, portable cervical visualization devices, and creative large-scale approaches to increase screening accessibility.SummaryOverall, a low-cost, accurate, point-of-care screening test could alleviate most of the barriers associated with cervical cancer screening in lower resource settings. Further research into the development of a low-cost HPV test in conjunction with the HPV vaccine and other screening tools could expedite progress. Cervical cancer disproportionately affects women in low to middle income countries. There are multiple barriers to implementing effective screening regimens at the level of the individual, community, and health care system. The HPV DNA test remains the most efficacious and cost-effective method for cervical cancer screening, but cost continues to be a barrier to implementation. Novel screening technologies such as self-sampling, urine testing, portable devices, and reliance on mobile and artificial intelligence technology can allow for point-of-care, affordable screening. Several low-to-middle income countries have implemented novel screening guidelines that have led to higher screening rates. HIV infection and prevalence remains a key consideration when developing cervical cancer screening programs in affected countries.