Cancer In Vietnam Research Articles

PCN115 - Cost-Utility Analysis of Erlotib Versus Standard Chemotherapy in First-Line Treatment of Advanced EGFR Mutation-Positive Non-Small Cell Lung Cancer in Vietnam

PCN115 - Cost-Utility Analysis of Erlotib Versus Standard Chemotherapy in First-Line Treatment of Advanced EGFR Mutation-Positive Non-Small Cell Lung Cancer in Vietnam

A Matched Case-Control Study of Risk Factors for Breast Cancer Risk in Vietnam.

Background. Vietnam has a low age-standardized incidence of breast cancer, but the incidence is rising rapidly with economic development. We report data from a matched case-control study of risk factors for breast cancer in the largest cancer hospital in Vietnam. Methods. 492 incident breast cancer cases unselected for family history or age at diagnosis and 1306 control women age 25–75 were recruited from the National Cancer Hospital (BVK), Hanoi. Structured interviews were conducted and pathology data was centrally reported at the National Cancer Hospital of Vietnam, in Hanoi. Results. Our analysis included 294 matched pairs. Mean age at diagnosis was 46.7 years. Lower mean parity, older age at first parity, increasing weight and BMI at age 18, and increasing BMI at diagnosis were positively correlated with breast cancer cases compared to controls. Age at first menarche and duration of breastfeeding were not statistically different between cases and controls. Conclusions. In this study we demonstrate that breast cancer in Vietnam is associated with some but not all of the published risk factors from Western populations. Our data is consistent with other studies of breast cancer in Asian populations.

PHS43 - Economic burden of Colorectal Cancer in Vietnam: from Healthcare payers’ perspective

PHS43 - Economic burden of Colorectal Cancer in Vietnam: from Healthcare payers’ perspective

PHS38 - Cost of Colorectal Cancer in Vietnam

Colorectal cancer (CRC) is the third most common cancer in both male and female in the world. Therefore, CRC causes the high economic burden for both patients and society. Understanding the cost of CRC is necessary to conduct the relevant healthcare policies, especially in Vietnam. This is also the aim of this study. A decision tree model was built to analyze the cost of each stage based on the National Comprehensive Cancer Network Guideline in 2013. The average cost of CRC was evaluated by using the following formula: COI = DC + IC. In which: COI - cost of illness, DC- direct cost, IC- indirect cost . The analysis was conducted based on the perspective of healthcare payers; therefore, only medical direct cost was evaluated. The cost of medical service and drugs were retrieved from the price-list of relevant medical services and drugs, registered by Ministry of Health in Vietnam 2012. The average direct cost of CRC for one patient accounted for nearly 756.83 million VND per year. Cost for one patient increased with the increasing of disease severity and accounted for 1.875 million VND; 800 million VND; 822 million VND and 1,351 million VND in stage I, II, III, IV, respectively. In the structure of cost, with the increase in severity of disease, the percentage of drug cost increased and the percentage of medical services decreased. The cost of CRC treatment increased following the increase of disease severity. The huge economic impact of CRC should be controlled and considered to conduct the proper healthcare policies.

Epidemiology of Hepatitis B and C Virus Infections and Liver Cancer in Vietnam.

Vietnam has been a highly endemic country of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections with high hepatitis B surface antigen (HBsAg) rate (8.8-19.0%) and high anti-HCV rate (1.0-3.3%) among general population. High mortality rates of liver cancer were also estimated from 14.8 to 23.7 per 100,000. Recently, the coverage of universal HB vaccination for infants has not been high as expected while there have been no other national programs against HBV and HCV infections yet. The burden of HBV and HCV-related diseases is predicted to remain a significant health problem in next decade.How to cite this articleDo SH. Epidemiology of Hepatitis B and C Virus Infections and Liver Cancer in Vietnam. Euroasian J Hepato-Gastroenterol 2015;5(1):49-51.

Screening mutations in miRNA196a2 and miRNA148a in Vietnamese breat cancer patients

Breast cancer, affecting women mostly, is the second common cancer in the world. Previous studies showed that miRNAs played a role in the regulation of signal transduction pathways in many different stages of cancer. The SNPs that occur on miRNA can have broad impact in cancer by many different ways. It was found that SNP rs11614913 C>T in miR-196a2 related to breast cancer risk in Asia. In addition, the association between SNP rs6977848 T> G in miR-148a and breast cancer have early proven on the Australian. In this study, a combination of Tetra-Arms-PCR and PCR product melting analysis,was used to screen for the presence of the allele of rs11614913 and rs6977848 in Vietnamese breast cancer patients. The results showed that the frequency of C and T allele ofrs11614913 were 58.96 % and 41.04 % respectively; the frequency of T and G allele of rs6977848 were 99 % and 1 %, respectively. Based on the genotype frequencies in the HapMap, rs11614913 is predicted to be associated with breast cancer while rs6977848 is probably not related to breast cancer in Vietnam due to a highly dominant frequency of only one type allele. However, there is still need for further research on a larger sample size to confirm the association between the two SNPs with breast cancer in Vietnam.

Epidemiology and prevention of prostate cancer in Vietnam.

Prostate cancer is the second most common cancer in men worldwide and a leading cause of mortality. Incidences continues to rise and vary substantially between populations. Although the prevalence of prostate cancer is relatively low in Vietnam, some hospital-based reports have shown an upward trend in recent years. While certain non-modifiable factors such as age, race and genetics are known to be mainly responsible, the literature has also suggested that environmental exposures can delay the onset of this disease. The present study provides a review of the epidemiology of prostate cancer in Vietnam by systematically searching several electronic databases. The results confirm an increasing trend of prostate cancer over the past decade, with age-standardised rate more than doubled from 2.2 per 100,000 men in 2000 to 4.7 per 100,000 men in 2010. However, no study has been found on modifiable risk factors, with the exception of one in vitro experiment that showed the inhibitory effect of garlic on the growth of prostate cancer cells. The lack of epidemiological information poses a difficulty to develop public health interventions to prevent this emerging malignant disease in Vietnam.

PCN164 - Cost-Utility Analysis of Trastuzumab in Treatment Of Metastatic Her2-Positive Breast Cancer in Vietnam

PCN164 - Cost-Utility Analysis of Trastuzumab in Treatment Of Metastatic Her2-Positive Breast Cancer in Vietnam

PCN64 - Cost of Breast Cancer in Vietnam

In recent years, breast cancer remains the leading cause of death in women worldwide. Evaluating the economic burden of breast cancer is very important due to long-term treatment with expensive drugs and medical services. In Vietnam related studies has not been conducted until now. This is also the aim of this study. The cost of breast cancer has been evaluated using pharmacoeconomic method “cost of illness” by following formula: COI = DC + IC in which: COI - cost of illness, DC- direct cost, IC- indirect cost A tree-decision model has been developed to evaluate the cost of different stages of breast cancer. This analysis was conducted based on the perspective of health insurance companies, therefore only direct medical costs were evaluated. The price of drugs and medical services have been averaged from the price-list of some major hospitals in Vietnam. The cost of disease for the whole society of Vietnam has been evaluated based on epidemiological data in Vietnam in 2013. The average cost of treatment per year of breast cancer in stage 0- I, II, III, IV accounts for 33,166,886; 287,057,068; 325,116,474 and 153,352,776 VND, respectively. In the structure of average cost with the increasing in severity of disease, the percentage of drug costs increase (from 28.7% in stage 0-I to 95.1% in stage 4) and the percentage of medical services decrease (from 71.3% in stage 0-I to 4.9% in stage 4). The cost of breast cancer for the whole society of Vietnam resulted in around 6,633 billion VND. The cost of breast cancer increases following the severity level of disease with the increasing percentage of drugs costs and reducing percentage medical services costs. The high cost of breast cancer for the whole society of Vietnam needs to be concerned to conduct the relevant health care policies.

Long-Term Breast Cancer Survival in Vietnamese Women

To the editor:The breast cancer incidence in Vietnam was consid-erably lower than that in the USA (1). Data on sur-vival of breast cancer in Vietnam are scarce. Thecurrent study examined the correlation of survivalwith prognostic factors and treatment of Vietnamesebreast cancer patients in Hanoi, Vietnam.Study participants (248) with primary breast cancer,were recruited at the National Cancer Hospital, Hanoi,Vietnam between June 2002 and October 2003.Patients were treated with modified radically mastec-tomy or conservative surgery and axillary node sam-pling (median: 10 lymph nodes excised). Histology wasclassified following WHO criteria. Tumor was gradedfollowing Scarff-Bloom-Richardson (SBR) and Elston-Ellis methods (2). Informed consent was obtained fromall patients before treatment. Patients with modifiedradical mastectomy were treated with adjuvant radio-therapy (tumors ≥3 cm: 50 Gy to the chest wall; andnode positive: 50 Gy to the axillary area). Patients withpartial mastectomy were given 50 Gy to the entirebreast and a booster (60–65 Gy) to the tumor bed.Patients with lymph node metastasis were receivedadjuvant chemotherapy as anthracycline or taxane, 4–6cycles.Hormone receptor content of tumors were definedas positive if immunohistochemistry results >1%stained nuclei. Patients with positive tumors werereceived endocrine therapy. The tumors were also ana-lyzed for HER2 expression and rate of cell prolifera-tion using an automated immunostaining platformand SISH procedure (3). The tumors were divided intofour categories: (a) Luminal A [ER(+) or/and PgR(+)and HER2( )]; (b) luminal B [ER(+) or/and PgR(+)and HER2(+)]; (c) HER2-enriched tumors [ER( ),PgR( ) and HER2(+)]; and (d) triple negative [ER( ),PgR( )andHER2( )].Comparison of clinicopathological characteristicsbetween premenopausal and postmenopausal patientswas performed using chi-squared test and odds ratio(OR). Disease-free survival (DFS) was calculated fromoperation date to the date of first detection of metasta-sis or contralateral breast cancer. Cancer-specific sur-vival (CSS) was calculated from operation date to thedate of death caused by cancer. Overall survival (OS)was calculated from operation date to date of death ofany cause or the last day of follow-up (July 31, 2011).Survival rates were estimated using Kaplan—Meiermethod. Log-rank test was used to compare DFS andOS between groups. We censored those who were stillalive after the last day of follow-up. Cox proportionalhazards models were used to determine the relation-ship between breast cancer deaths and prognosticfactors and treatment.Median follow-up time was 99 months. Of 248patients, 159 patients were premenopausal, 85 post-menopausal, and four unknown menopausal statuses.During follow-up, 48 patients died from breast cancer.Table 1. Relationship between Clinical Character-istics and Survival in Univariate and MultivariateModels

Cost-Effectiveness Analysis of a Screening Program for Breast Cancer in Vietnam

ObjectiveThis study aimed to evaluate the cost-effectiveness of a screening program for breast cancer from the health care payers’ perspective. MethodsA Markov model was used to compare costs and effects of an annual screening program using clinical breast examination (CBE) with the absence of screening on a cohort of 4,103,285 asymptomatic women aged 40 years. The model was analyzed over the cohort’s lifetime under the assumption that women participated in the screening program annually for 15 years. The model integrated both epidemiological and cost data for breast cancer from prior Vietnamese studies. Costs were measured in 2008 US dollars. Costs and effects were discounted annually at 3%. The incremental cost-effectiveness ratio (ICER) was defined as the difference in cost per life-years saved (LYS). One-way and probabilistic sensitivity analyses were implemented to assess the uncertainty of inputs. ResultsThe ICER for the breast cancer screening program with CBE was US $994.96 per LYS compared with the absence of screening. Earlier initiation of the program at age 35 years increased the ICER to US $1196.68 per LYS, while extending the duration of time screened to age 60 years decreased the ICER. Changing the participation rate to 70%, reducing the specificity of CBE testing, and increasing the cost of the screening program by 30% raised ICER estimates to US $1419.32, US $1124.15, and US $1292.03 per LYS, respectively. ConclusionBreast cancer screening with CBE for women aged 40 to 55 years is considered very cost-effective in Vietnam according to the World Health Organization criteria.

Survival probability and prognostic factors for breast cancer patients in Vietnam

Background: Breast cancer is becoming a public health problem in Vietnam. The mortality to incidence ratio of the disease was ranked second among the most common cancers in women. This study estimates the survival probability at 1, 3, and 5 years following diagnosis and determines prognostic factors for breast cancer mortality in Vietnam.Methods: A survival analysis was conducted based on retrospective data from Hue Central Hospital and the Cancer Registry in Ho Chi Minh City. Using the Kaplan-Meier method, the survival probability of patients with breast cancer was estimated at 1, 3, and 5 years following diagnosis. The covariates among prognostic factors for survival time were studied using an extended Cox proportion hazards model, including time-dependent predictors.Results: Overall survival rates at 1, 3, and 5 years following diagnosis were 0.94, 0.83 and 0.74 respectively. Marital status, education level, stage at diagnosis, and hormone therapy were prognostic factors for mortality. For the stage at diagnosis, the relation to the risk of death for breast cancer was 1.32 (95% CI, 1.22–1.41). Married women faced a risk of death nearly 1.59 times higher than unmarried women (95% CI, 1.09–2.33). Women with higher levels of education and who received hormone therapy had approximately 10% (hazard ratio [HR]: 0.92; 95% CI, 0.89–0.96) and 80% (HR: 0.22; 95% CI, 0.12–0.41) risk reduction of death respectively, compared with those classified as illiterate and those without hormone therapy.Conclusions: The 5-year survival probability of breast cancer was lower in Vietnam than in countries with similar distributions of the stage at diagnosis. Screening programs and related support policies should be developed to increase the life expectancy of women with breast cancer in Vietnam.

Acceptabilité de la vaccination contre les papillomavirus humains (HPV) par les pédiatres, les mères et les jeunes femmes à Hô Chi Minh Ville, Vietnam

BackgroundCervical cancer (CC) is almost always induced by some oncogenic types of human papillomavirus (HPV). In Vietnam, it is the first leading cause of cancer in women, with highest prevalence in Ho Chi Minh City (HCMC). Since 2006, prevention of the CC has been improved by licensure of recombinant vaccines directed against HPV 16 and 18, effective when administered before the age of first sexual intercourse. A national program for routine immunization of pre-adolescent girls in addition to cytological screening of adult women would greatly reduce the impact of CC in Vietnam but vaccines remain expensive and it is unclear how this strategy would be accepted by the target population. The aim of this study was to assess the acceptability of HPV vaccination by pediatricians, mothers with a daughter aged 9–15years and young women aged 16–26years in HCMC. MethodsBetween March and June 2010, a cross-sectional survey of knowledge and attitudes was administered to 115 pediatricians in the pediatric hospital, 210 mothers and 400 young women attending the gynecology department of the University Hospital. ResultsPediatricians generally had a good perception of the risk but they still lacked knowledge about HPV vaccination, given by 66% of them. Among mothers, 18% knew the relationship between HPV infection and CC, 43% had heard of HPV vaccination and 40% agreed to vaccinate their daughter. Among young women, 35% knew the risk, 49% knew the vaccine and 38% wanted to be vaccinated. Level of education, amount of income and celibacy were positively related to intention to be vaccinated. The lack of information on HPV vaccination and the high cost of vaccines were the main causes of refusal or indecision. ConclusionRoutine HPV vaccination of girls in HCMC will be well accepted by the population if a large campaign of health education is implemented by the government and if the affordability of vaccines is facilitated.

Lessons learned from successful Papanicolaou cytology cervical cancer prevention in the Socialist Republic of Vietnam.

In 1996, we documented that the burden of cervical cancer in Vietnam was associated with troop movements during the Vietnam War. Subsequently, establishment of Papanicolaou screening in southern Vietnam was associated with reductions in cervical cancer incidence from 29.2/100,000 in 1998 to 16/100,000 in 2003. This is one of the first English-language reports of a real-world cervical cancer prevention effort associated with a decisive impact on health outcomes in a contemporary developing country. Lessons learned: if our ideological commitment is to improve health outcomes as rapidly as possible among as many people as possible, then Papanicolaou screening (with or without HPV or visual screening) must be implemented without further delay in any setting where cervical screening is appropriate but unavailable; consideration must be given to HPV vaccination after, rather than before, full coverage of target demographic groups by screening services has been achieved and/or the possibility has been excluded that HPV vaccination may be ineffective for cancer prevention. Competing ideological commitments engender imprudent yet commercially useful alternative strategies prone to decelerate global reductions in mortality by suppressing the more-rapid uptake of less-expensive open-source technology in favor of the less-rapid uptake of more-expensive proprietary technologies with uncertain real-world advantages and unfavorable real-world operational limitations. Global cervical cancer prevention efforts will become more effective if global health leaders, including the Bill & Melinda Gates Foundation, embrace an ideological commitment to improving health outcomes as rapidly as possible among as many people as possible and assimilate the policy implications of that commitment.

Family history, BRCA mutations and breast cancer in Vietnamese women

The purpose of this report is to estimate the proportions of familial and hereditary breast cancers among unselected cases of breast cancer in Vietnam. Two hundred and ninety-two unselected cases of incident breast cancer were recruited from the National Cancer Hospital, Hanoi, the largest cancer centre in Vietnam. Family histories were collected for 292 cases and a DNA sample was obtained for 259 cases. DNA samples were screened for mutations in the large exons of BRCA1 and BRCA2 using the protein truncation test and by allele-specific testing for 17 founder mutations which have been reported in other Asian populations. Complete gene sequencing was performed on two cases of familial breast cancer. Seven of 292 cases reported a relative with breast cancer and one patient reported a relative with ovarian cancer. A pathogenic BRCA mutation was detected in 2 of 259 cases; one BRCA1 carrier was diagnosed at age 51 and one BRCA2 carrier was diagnosed at age 42. Neither case reported a relative with breast or ovarian cancer. A family history of breast cancer is very uncommon among Vietnamese breast cancer patients. The frequency of pathogenic BRCA mutations in Vietnamese breast cancer patients is among the lowest reported worldwide.

Toxicities and response of concurrent chemoradiotherapy for stage IIB-IIIB cervical cancer.

e15549 Background: Cervical cancer is the most common cancer in women in Vietnam. Concurrent chemoradiotherapy (CCRT) has been proved survival benefit and emerged as the standard treatment of locally advanced cervical cancer. However, it significantly increases early toxicities. This study evaluated the acute toxicities and responses of CCRT in treatment of stage IIB-IIIB cervical cancer in Vietnam. Methods: From November 2006 to December 2007, 60 patients with stage IIB-IIIB cervical cancer were treated by CCRT. EBRT consisted of 40 Gy/20 fractions, followed by 10 Gy boost to the parametrium and intracavitary HDR brachytherapy 7 Gy to point A/fraction/week in 3 fractions. Chemotherapy with cisplatin 40 mg/m2/weekly for 6 cycles started by the first day of EBRT. Results: All the patients completed treatment protocol. Grade 3-4 leukopenia, neutropenia, and thrombocytopenia were 40%, 33.3%, 8.3% respectively. 19 cases (31.7%) had renal toxicity (grade 1: 16 cases, grade 2: 2 cases, and grade 3: 1 case). Grade 3-4 toxicities increased sharply after the fourth cycle of chemotherapy. Mean overall treatment time is 72 days. 15 patients (25%) had to delay treatment mainly due to hematologic toxicity (10/15 cases). The overall response rate was 96.7% (complete response: 81.7%; partial response: 15%). Conclusions: CCRT is relatively high hematologic toxicities and high response rate. This study pointed out the relationship between the risk of toxicities and number of chemotherapy cycles. CCRT with 5 cycles of chemotherapy would decrease toxicities and overall treatment time. No significant financial relationships to disclose.

Detection of two novel mutations and relatively high incidence of H-RAS mutations in Vietnamese oral cancer

Oral squamous cell carcinoma is the sixth most common cancer in the world and the seventh most common cancer in Vietnam. The RAS and PI3K-AKT signaling pathways play an important role in oral carcinogenesis. Our previous study on PI3K signaling pathway showed the absence of PIK3CA and PTEN gene mutations in Vietnamese oral cancer. We thus hypothesized that the RAS could be more likely activated as an upstream effector. However, the status of RAS mutations in Vietnamese oral cancer had not been studied. In the present study, Fifty six primary tumor DNA samples were screened for mutations of hot spots in exons 1 and 2 of H-RAS and a part of the samples for exon 7 of ERK2 gene in which we previously reported a mutation in an OSCC cell line. The H-RAS mutations were detected in 10 of 56 tumors (18%). Two novel mutations were found, one was an insertion of three nucleotides (GGC) between codons 10 and 11 resulting in in-frame insertion of glycine (10(Gly)11) and the other was a missense mutation in codon 62 (GAG>GGG). We also found T81C single nucleotide polymorphism in 12 of 56 tumors (22%) and there was no mutation in exon 7 of ERK2 gene. The H-RAS mutation incidence showed significant association with advanced stages of the tumor and also with well-differentiated tumor grade. Our study is the first to report H-RAS mutation from Vietnamese ethnicity, with two novel mutations and relatively high incidence of H-RAS mutations. The results suggest that RAS is an important member in the PI3K-AKT signaling and could play an important role in the tumorigenesis of oral carcinoma.

High Incidence of Larynx Cancers in Vietnamese Population in the Bay Area

Agent Orange exposure has been implicated in the development of laryngeal cancers in Vietnam (VN) War veterans. We hypothesize that Vietnamese immigrants were also exposed to Agent Orange and similarly prone to developing laryngeal cancers. This study's objective is to compare the incidence of laryngeal cancers and of other non-Agent Orange related head and neck (HN) cancers in the VN population in California to that in other Asian ethnicities in the same state as well as to non-Asians in the country. Data from the U.S. Surveillance Epidemiology and End Results (SEER) and the California Cancer Registry databases were analyzed for the period between 1988 and 2006. 57,592,725 Asians and 548,807,029 non-Asians formed the study groups. Incidence rates of HN cancers were analyzed based on primary tumor site (oral cavity, oropharynx, larynx, hypopharynx and nasopharynx), time period (1988-1993, 1994-1999, 2000-2006), ethnicity (Vietnamese, Chinese, Japanese, Filipino, Korean, Asian Indian and non-Asian) and gender (male, female). The statistical analyses were conducted with SEER∗Stat (http://seer.cancer.gov/seerstat/). VN males had the highest incidence rate of laryngeal cancers, mainly squamous cell carcinomas, among all Asian males in California. The incidence rate was 5.1-10 per 100,000 person-years for VN, 2.7-3.8 for Chinese, 1.8-3.3 for Japanese, 2.7-3.1 for Filipino, 3.8-6.8 for Korean, 2.2-6.2 for Asian Indian and 5.5-8.4 for non-Asian males. The difference was statistically significant between VN males and other Asian male subgroups except for the Korean males for all time periods evaluated. There was no significant difference in the incidence of laryngeal cancers among different female groups evaluated. For other HN cancer sites listed, there was no significant difference in the incidence rate between VN population and other Asian ethnicities, except for nasopharyngeal cancer, where the VN group had the 2nd highest incidence (5.7-8.2 for VN males and 2.4-3.7 in VN females), just behind the Chinese, and they were statistically significantly higher than the non-Asian population and other non-Chinese Asian groups for all analyzed time periods. The incidence of laryngeal cancer is higher in VN males compared to other Asian subgroups in California. This may be related to the combination of Agent Orange exposure and smoking habits. Further work is needed to establish the link between Agent Orange and laryngeal cancer in VN patients.

Epstein-Barr virus genetic variation in Vietnamese patients with nasopharyngeal carcinoma: full-length analysis of LMP1

Genetic variation in tumor virus genes and its impact on function might contribute to the understanding of geographic differences in risks for virus-associated tumors. This is particularly true for the genes known to contribute to the biology of the tumor. It is has been proposed that Epstein-Barr virus (EBV) gene variation has a role in the high risk of nasopharyngeal carcinoma (NPC) in South-East Asia. NPC is among the five most common cancers in Vietnam. EBV-NPC cells always express EBV nuclear antigen 1 (EBNA1) and also frequently latent membrane protein 1 and 2 (LMP1 & LMP2). To investigate EBV gene variation in Vietnamese NPC patients we analyzed the full length of LMP1 gene including its promoter region, and the N-termini of both EBNA1 and LMP2A genes from five NPC biopsies. We detected two EBV variants V1 and V2 based on the LMP1 nucleotide sequence pattern compared with the prototype B95-8 and some available sequences including Chinese variants. The V1 variant shows strong similarity to a variant dominant in Southern China (China 1), while the V2 variant is similar to a Thai variant SEA 2 and partly identity with GD1 in the C-terminus. The promoter region and transmembrane domain of the SEA 2-like samples contained some specific differences compared with previously published variants. In contrast, analysis of EBNA1 N- and LMP2A N-termini only revealed minor changes. Our findings reinforces that the polymorphisms of whole LMP1 sequence should be considered in future EBV molecular epidemiology studies in different geographic populations.

Systems Analysis of Real-World Obstacles to Successful Cervical Cancer Prevention in Developing Countries

Papanicolaou screening is feasible anywhere that screening for cervical cancer, the leading cause of cancer-related death among women in developing countries, is appropriate. After documenting that the Vietnam War had contributed to the problem of cervical cancer in Vietnam, we participated in a grass roots effort to establish a nationwide cervical cancer prevention program in that country and performed root cause analyses of program deficiencies. We found that real-world obstacles to successful cervical cancer prevention in developing countries involve people far more than technology and that such obstacles can be appropriately managed through a systems approach focused on programmatic quality rather than through ideological commitments to technology. A focus on quality satisfies public health goals, whereas a focus on technology is compatible with market forces.