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• W4386736005 abstract "Cervical cancer is one of the leading causes of cancer-related deaths in women globally, and Pakistan is no exception to this1. Cervical cancer is the fourth most common cancer globally, which is diagnosed mostly in women younger than 35 years of age. Cervical cancer ranks as the third most frequent cancer among women in Pakistan and the second most frequent cancer after breast cancer among women between 15 and 44 years of age2. According to the World Health Organization, Pakistan has the highest incidence of cervical cancer in South Asia. Pakistan has a population of 73.8 million women ages 15 years and older who are at risk of developing cervical cancer3. Every year around 5008 women are diagnosed with cervical cancer and 3197 die from the disease4. The lack of awareness about the importance of screening and preventive measures has led to an increased incidence of cervical cancer in Pakistan5. The exact incidence and prevalence of cervical cancer are not known in Pakistan because it is an ignored disease in terms of diagnosis and prevention. Unfortunately, inadequate cervical cancer testing facilities in Pakistan have become a major public health concern6. Many hospitals and clinics do not offer cervical cancer screening, especially in rural areas. Screening tests help in the early detection and appropriate treatment of cervical cancer, decreasing the mortality rate significantly. These screening methods include: Pap smear, liquid-based cytology, human papillomavirus (HPV)-DNA testing, and the visual inspection with acetic acid. Cervical cytology is the gold standard. According to American Cancer Society Guidelines, cervical cancer screening should begin at age 257. In Pakistan, cervical cancer screening is advisable in women aged 25–44 years after every 3 years and for women aged 45–60 years after every 5 years because it is extremely rare under 25 years and unlikely to develop cervical cancer after 64 years8. However, many women are not aware of the risk of cervical cancer and they do not know about the screening. According to a study, only 5% of women in Pakistan are aware of screening and only 2.6% of women have a screening test once in their life9. The nonconfident nature of women and lack of encouragement from families are the major barriers to carrying out screening in Pakistan10,11. Although some hospitals and clinics offer screening services, such as Pap smear test, they are usually only available in major cities because it requires skilled personnel and laboratory facilities to perform and interpret the test results accurately. In addition, cultural barriers and a lack of awareness about the importance of cervical cancer screening can prevent women from seeking screening services, further exacerbating the lack of access to diagnostic facilities12. The country’s health care infrastructure is insufficient, and resources are limited, which makes it challenging to establish adequate screening programs across the country. There is also a shortage of health care professionals, and the ones who are available, often lack the necessary training to conduct effective screening tests11,13. The stigma surrounding women’s health, the taboo nature of cervical cancer, and its testing procedure can further discourage women from seeking screening services. The social, cultural, and religious factors in Pakistan prevent women from visiting health facilities and discussing their reproductive health issues openly14. Women may not opt for screening due to fear of discomfort associated with the procedure, and the likelihood of being examined by a male doctor. Furthermore, rampant health illiteracy leads to a poor understanding of the disease and the significance of screening resulting in a lack of perceived necessity15. The inadequate screening for cervical cancer in Pakistan has a number of negative consequences, such as late detection makes it more difficult to treat, and it leads to a high mortality rate. It puts a strain on the health care system, as more women are diagnosed with advanced-stage cervical cancer and require more expensive treatment6. The development of vaccines against HPV has been a major breakthrough in the prevention of cervical cancer. In Pakistan, the use of HPV vaccines is still limited, but their potential to reduce the burden of cervical cancer is significant16. However, despite the effectiveness of HPV vaccines, their use in Pakistan is still limited due to various factors, including high cost, lack of awareness about the vaccines, and cultural barriers. In addition, there are logistical challenges to the distribution and administration of vaccines in remote and underserved areas, where the burden of cervical cancer is often highest17. There are still several challenges to the widespread adoption of HPV vaccines in Pakistan, including a lack of infrastructure and resources, concerns about vaccine safety, and cultural and religious beliefs that may discourage vaccine uptake. HPV elimination recommendations: Establishing comprehensive cervical cancer screening programs that are accessible and affordable for all women, particularly those in rural and remote areas. Training health care providers on screening techniques and diagnosis. Providing necessary laboratory facilities and equipment to ensure accurate and reliable screening results. Conducting public awareness campaigns to educate women about the importance of cervical cancer screening and early detection. Removing social and cultural barriers that prevent women from seeking screening services. These services are not for cancer, however, they test for the prevention of cervical cancer. The government needs to take immediate action to establish these measures to ensure that all women have access to quality cervical cancer screening and diagnostic services. Ethical approval Not applicable. Sources of funding Not applicable. Author contributions M.A.: data collection, analysis, and written original draft. E.N.: conceptualized the study and interpretation of the data. I.A.: reviewed, edited, and approved the final version of the manuscript. M.H.B.: supervision. Conflict of interest disclosures The authors declare that there are no conflicts of interest. Research registration unique identifying number (UIN) Not Applicable Guarantor Mohammed Hussen Bule" @default.
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• W4386736005 date "2023-09-01" @default.
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• W4386736005 title "Inadequate cervical cancer testing facilities in Pakistan: a major public health concern" @default.
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• W4386736005 doi "https://doi.org/10.1097/gh9.0000000000000336" @default.
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