Taking a small sample of cells from women at high-risk of cervical cancer could be a cost-effective and accurate strategy for early diagnosis in low and middle income countries (LMICs), according to research led by Queen Mary University of London (QMUL), funded by Cancer Research UK and published in the Journal of Global Oncology.
Cervical cancer is the second most common cancer in women in developing countries, and globally some quarter of a million women die from the disease each year - most of them from LMICs.
To reduce the incidence of cervical cancer in developed countries, nationwide screening is offered to all women. Taking a small cluster of cells ('cytology') to diagnose disease before it progresses to cancer has been extremely effective. But in less developed countries, a lack of infrastructure and quality management have hampered widespread implementation of effective screening programmes.
In the first study to evaluate the use of cytology to diagnose cervical cancer in LMICs, the researchers looked at cytology results from 717 cervical cancers from 23 studies in countries including India, Bangladesh, China, Thailand, Kenya, South Africa, Uganda, Peru, El Salvador, Costa Rica, Nicaragua, Brazil, Argentina and Egypt. They argued that cytology in these countries might be used to diagnose cervical cancer earlier.
The researchers found that even in these low-resource settings, cytology was very sensitive and consistent for detecting invasive cancer. Cytology was found to successfully find cancer with 95.9 per cent accuracy in high-risk women showing symptoms.
Corresponding author Dr Alejandra Castanon from QMUL said: "Cytology has long been established as an excellent screening tool to prevent cervical cancer by detecting precancerous lesions. However, little research has been carried out regarding its sensitivity to cancer.
"We've found that this is an excellent tool for targeted screening of populations at high risk of cervical cancer, leading to early diagnosis. In resource-poor settings with limited facilities to treat advanced cancers, this could have a big impact on cervical cancer mortality."
The researchers say that restricting cytology to symptomatic women and referring only those with severe lesions would lead to substantially fewer women requiring further investigation. This could mean a reduction in burden on resource and cost, and could result in the diagnosis of cervical cancers at an earlier stage to improve overall survival from the disease.
Co-author Professor Peter Sasieni from QMUL added: "The implications are that, even when a country lacks infrastructure to implement a quality-assured cervical screening programme nationally, it might be able to facilitate early diagnosis of cervical cancer by using cervical cytology, and only referring women with severely abnormal smears."
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Notes to the editor
Research paper: 'Systematic review and meta-analysis of individual patient data assessing the sensitivity of cervical cytology for diagnosing cervical cancer in low and middle income countries'. Alejandra Castanon, Rebecca Landy, Dimitrios Michalopoulos, Roshni Bhudia, Hannah Leaver, You Lin Qiao, Fanghui Zhao, Peter Sasieni. Journal of Global Oncology 2017.
About Queen Mary University of London
Queen Mary University of London (QMUL) is one of the UK's leading universities, and one of the largest institutions in the University of London, with 23,120 students from more than 155 countries.
A member of the Russell Group, we work across the humanities and social sciences, medicine and dentistry, and science and engineering, with inspirational teaching directly informed by our research. In the most recent national assessment of the quality of research, we were placed ninth in the UK (REF 2014).
As well as our main site at Mile End -- which is home to one of the largest self-contained residential campuses in London - we have campuses at Whitechapel, Charterhouse Square, and West Smithfield dedicated to the study of medicine, and a base for legal studies at Lincoln's Inn Fields.
We have a rich history in London with roots in Europe's first public hospital, St Barts; England's first medical school, The London; one of the first colleges to provide higher education to women, Westfield College; and the Victorian philanthropic project, the People's Palace at Mile End.
Today, as well as retaining these close connections to our local community, we are known for our international collaborations in both teaching and research.
QMUL has an annual turnover of £350m, a research income worth £125m (2014/15), and generates employment and output worth £700m to the UK economy each year.
Journal of Global Oncology