Prevention strategies of cervical cancer in developing countries: The case of Madagascar

Introduction: Cervical cancer remains a major public health challenge in women throughout the World. Human Papilloma Virus (HPV) vaccination and screening are recommended for its prevention. These prevention strategies are not always applicable in some developing countries due to financial constraints and limited availability. In Madagascar, although national HPV vaccination program is not yet implemented and HPV testing is not affordable for widespread deployment, PAP smear represents the main screening approach for cervical cancer prevention.  

Objective: The purpose of this study is to evaluate the use of PAP smear screening in Haute Matsiatra region of Madagascar. 

Materials and methods: 

This is a multicenter retrospective and descriptive study of all Pap smears reported from May 2021 to May 2022 at three Pathology Departments serving the Haute Matsiatra region.  

Results: 

A total of 3268 conventional Pap smears were processed and evaluated; of these, 3164 (96,81%) were mainly performed for the purpose of screening. The mean age of women was 38,68 years. A cervical lesion was detected in 596 cases (18,23%), including 25 cases (4,19%) of squamous cell carcinoma, 3 cases (0,50%) of adenocarcinoma, 59 cases of HSIL (9,90%), 152 cases of ASCH (25,50%), 95 cases of LSIL (15,94%), 187 cases of ASCUS (31,38%) and 75 cases (12,58%) with atypical glandular cells. Among those with abnormal Pap smear, 29,69% (n=177) underwent colposcopy and biopsies were done in 13,25% (n=79). 

Conclusion 

Our study demonstrated the importance of Pap smears screening for early detection of premalignant and malignant lesions of cervix. Therefore, conventional Pap test remains an usefull method  for cervical cancer prevention in Haute Matsiatra region.