Cervical cancer in South Africa: screening status and policy pitfalls


High quality cervical cancer screening can reduce the incidence of and the mortality from cervical carcinoma. This because the natural evolution of cervical carcinoma, i.e.  the progression and regression of precursor lesions and the period of time from detection of a precursor lesions to the clinical manifestation of cervical carcinoma allows for the detection of preinvasive cervical carcinoma.  Since cervical cancer is the only cancer that is almost completely preventable through regular screening, further implementation of effectively organised screening programs and improvement of existing screening strategies and technologies will inevitably decrease the burden of this disease.

This thesis reviews the incidence of cervical carcinoma as well as the impact of human papilloma virus infection in combination with the high burden of HIV, in South Africa..  Primary and secondary preventative strategies, as well as the achievements and limitations of the current cervical cancer screening policies are discussed in detail. The inequality of the geographical distribution (both rural and urban) of preinvasive as well as invasive cervical carcinoma is a major pitfall for the screening policies. 

The standard method of cervical screening has resulted in the diagnoses of many pre-invasive and invasive cervical carcinomas.  However, a shift to a molecular approach could improve screening.  The evaluation of LBC as well as HPV equipment is discussed.  Further studies should be done to ascertain the suitability of the various assays for the South African diverse population.

The General discussion indicates that the way forward for the diagnosis and management of cervical carcinoma is not “one size fits all”.  Future cervical cancer screening programs should be organised and diversified with different approaches for the vaccinated and non-vaccinated cohorts, the rural and the urban inhabitants as well as the HIV positive/negative women.  Further research is required to determine which of the strategies (or combinations thereof) are the best and most affordable for the South African population.