[The Medical Situation in Developing Countries]

How do developing countries prevent cervical cancer?

  According to WHO, Cervical cancer is the fourth most frequent cancer in women with an estimated 530,000
new cases in 2012 representing 7.9% of all female cancers. Approximately 90% the 270,000 deaths from cervical
cancer in 2015 occurred in low- and middle- income countries.

Cervical cancer is preventable. Nevertheless the incidence rate of cervical cancer in developing countries is still
high since screening test and HPV vaccination are limited. Pap smear had become the gold standard for cervical
cancer screening which follows relatively simple procedure and cost-effective. However in developing countries
materials and human resources for Pap smear are not easily provided. HPV vaccination is of course limited to
many people.

  For women in developing countries, cervical cancer screening that can be applied to current situation is required.
The most suitable screening test is VIA (Visual Inspect with Acetic acid). VIA is a screening for cervical cancer
which uses 3~5% acetic acid and evaluate the result with naked eye. The results are simply VIA-Negative and
VIA-Positive or suspicious for cancer. With the sensitivity of VIA, It is not easy to distinguish abnormalities.

  VIA and Cervicography both uses 5% acetic acid for test. However in South Korea, Cervicography is only
commonly used for cervical cancer screening. VIA also follows its own algorithm however VIA does not have
system for evaluation and therefore only VIA provider can evaluate the current status of cervix. Consequently,
the critical factors such as variation and consistency can hardly maintained. On the other hand Cervicography
guarantees objectivity by evaluating with multiple evaluators. Since Cervicography evaluators have completed
evaluator tutorials and passed examinations, they detect not only acetowhite lesion but also other morphological
significance such as punctuation, irregular surface contour, discoloration, atypical vessel etc. Moreover images
taken by Cervicography can be stored for follow-up and marks on images helps physicians where to biopsy.

  There is a limit of cervical cancer screening with VIA. However VIA is the only answer for women in developing
countries. Recently Cervicography is used for VIA education. Since Cervicography is a Tele-medicine system,
images taken by trained nurse or midwife in developing countries can be evaluated by evaluators from other
countries. Consequently healthcare center affordable for cervical camera tends to use Cervicography for cervical
cancer screening.

[Medical Situation in Malawi by Prof. Haeok Lee]

“When I visited Malawi, funding from other countries supplied HIV or AIDS test kits and medicine and
consequently many women could have been escaped from serious diseases. However I found out that women
survived from HIV or AIDS lost their lives by cervical cancer. In South Korea, cervical cancer develop in old-age
yet cervical cancer patients in Malawi were aged around 30. Due to expose to HIV, cervical cancer cells grow
relatively rapid in women from developing countries however there was no place for cervical cancer screening.
Pap smear is simply not available in Malawi where one day wage is only US$1. The most suitable screening test
is VIA.
Countries lack of resources and physicians like Malawi requires easy-and-fast screening test to distinguish
Negative and obvious cancer and other cases that cannot be evaluated by VIA will be sent to Cervicography
evaluators through Tele-medicine system. I will visit Malawi again for VIA training by Cervicography for nurses
and midwives and proceed clinical research with NIH, Harvard Dana-Farber Cancer Institute. I really hope this
great Cervicography system will be applied to low-resource setting areas and save women from cervical cancer."