As part of the Binaytara Foundation and Cancer Care Nepal Cervical Cancer Screening project, 1000 women were screened for cervical cancer and inflammatory diseases of the cervix at several screening camps organized in Bara, Kathmandu, and Latitpur Districts.
Cervical Cancer Background
Worldwide, cervical cancer is the second most frequent cancer type and the third greatest cause of death from cancer in women (WHO Fact Sheet, 2013). Of the more than 270,000 deaths from cervical cancer every year, more than 85% occur in developing countries 1. One such country is Nepal, located in South Asia between India and China with a population of 26.5 million (U.S. Census, 2011). In 2008 it was estimated that more than 3,500 new cases of invasive cervical cancer arise in Nepal each year, accounting for 21% of all cancers in women 2.
Fortunately, cervical cancer is preventable with effective screening. The U.S. Preventive Services Task Force recommends screening for women 21-65 years old with cytology every three years; for women 30-65 years old who wish to lengthen their screening interval, screening with a combination of cytology and HPV testing should occur every 5 years. Due to lack of access to healthcare and lack of resources, far too many women in developing countries do not get screened for cervical cancer or are often diagnosed at an advanced stage.
Cervical cancer screening aims to prevent the development of cancer by identifying high-grade, pre-cancerous cervical lesions 3. When screening detects pre-cancerous lesions, these can easily be treated. Screening also detects cancer at an early stage where treatment has a much higher rate of success. Because pre-cancerous lesions take many years to develop, screening is recommended for women ages 30-65 at least once in her lifetime and ideally more frequently 1.
Cervical Cancer is the most frequent cancer affecting women in Nepal. Approximately 3.2 million Nepalese women aged 30-60 years currently require screening for cervical cancer, yet only an estimated 2% of women have received such screening due to limited testing facilities and programs. A recent cervical cancer screening conducted by the Cancer Care Nepal with 3,829 women between the ages of 30-60 revealed that 0.31% of the participants had early cancers of the cervix while 63.5% had inflammatory diseases of the cervix.
The Binaytara Foundation has partnered with Cancer Care Nepal to develop a screening program for low and middle income women between the ages of 30-60 who live in the rural and suburban districts of Kathmandu and Lalitpur, Nepal. The cervical cancer screening program will span a period of six months with follow-up medical care based on individual screening results.
- Prevent mortality associated with cervical cancer in developing countries
• Screen women between the ages of 30-60 for presence of cervical cancer
• Provide appropriate treatment to women diagnosed with pre-cancerous, cancerous, or inflammatory lesions of the cervix.
Using conventional (Pap) and liquid-based Cytology, an estimated 5,000 women between the ages of 30-60 will be screened for lesions of the cervix. Depending on results, participants will receive follow-up care according to U.S. Preventive Services Task Force recommendations: High-grade lesions may be treated with ablative and excisional therapies including cryotherapy, laser ablation, loop excision, and cold knife conization. Early-stage cervical cancer may be treated with surgery (hysterectomy) or chemoradiation3.
Once the initial enrollment of the participants is complete and Pap smear tests are scheduled for each participant, the cervical cancer screening team will collect samples for evaluation by the pathology lab. Participants will then be contacted for follow up medical care based on their results. Participants with pre-cancerous or cancerous lesions will be offered surgery and those with inflammatory lesions of the cervix will be treated with antimicrobial agents. All participants including those with normal findings will be provided educational materials and counseling on the prevention of cervical cancer.
1.) WHO Fact Sheet, Sept 2013. http://www.who.int/mediacentre/factsheets/fs380/en
2.) Nour, NM (2009). Cervical cancer: A preventable death. Reviews in Obstetrics and Gynecology, 2(4), 240-244. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812875/
3.) Screening for Cervical Cancer: Clinical Summary of U.S. Preventive Services Task Force Recommendation. AHRQ Publication No. 11-05156-EF-3, March 2012.http://uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancersum.htm