Cervical cancer screening in Thailand: Limitations and alternatives

Abstract

The key in cervical cancer prevention is to link the treatments of pre-invasive disease with the screening methods used, especially when it becomes positive. Previous Pap smear based cervical cancer prevention in Thailand was not effective because about 5,000 Thai women annually die of this cancer and this toll has been amassing for decades. The age-standardized incidence ratio (ASR) is 19.5 per 100,000 women-years. A multi-province survey by the Thai National Cancer Institute found that coverage of the previous cervical cancer screening program (i.e. the opportunistic Pap smear) was only 5%. Half of the women with abnormal Pap smear may not come for further investigations and treatments. Human papillomavirus (HPV) prophylactic vaccines and HPV testing are still expensive, causing them impossible for using in public health program. Visual inspection with acetic acid (VIA) and cryotherapy, a secondary prevention program by trained nurse providers, could be more practical approaches for preventing cervical cancer, particularly in low resources, rural and remote settings. This program in conjunction with the use of the Pap smear, which is to be used only when appropriate, aims to achieve 80% coverage as recommended by the World Health Organization (WHO). Using both methods in a complementary fashion to achieve its goal should significantly reduce the incidence and mortality of cervical cancer among Thai women. © 2012 Nova Science Publishers, Inc. All rights reserved.