In the past, cervical cancer was one of the leading cancer killers of women around the world. The cancer occurs on the opening of the uterus ? it's a location not easily detected by a woman until it's too late. The number of cervical cancer deaths has changed in the 1950s since the widespread introduction of the Pap test. The test is named after a Greek doctor, Georgios Papanikolaou, who found that examining a sample of cells taken from the cervix could identify cancer very early. In countries where the Pap test is widely used now, cervical cancer deaths have plunged by as much as 90 percent. But, as Rose Hoban reports, results of a new survey show that in too many countries, too few women are screened for cervical cancer.

The data comes from a set of surveys carried out by the World Health Organization in 2002 and 2003. Surveyors went door to door in dozens of developing countries to ask women if they had ever had a pelvic exam or a Pap test.
Doctor Ziad Obermeyer from the University of Washington examined this data. "If you look at whether or not the respondents have ever had a pelvic exam, that number was at about 70 percent in developed countries and at 45 percent in the developing world," he says. "In some of these countries the rates were just staggeringly low. If you look at rates in Ethiopia, Bangladesh, or Burma, Myanmar, 90 percent of women had never had a pelvic exam. And only 1 percent of women had been effectively screened."
Obermeyer says these numbers are consistent with what's already known: most of the world's deaths from cervical cancer take place in developing countries. The World Health Organization estimates there are about half a million cases worldwide every year, and about half those women die from the disease.
Obermeyer says changing this screening rate will be challenging. "I think that the one bottom line from our paper, which is highlighted by the fact that there is such a variety of screening practices, is that there is not going to be a one-size-fits-all strategy that will work for every country."
Obermeyer says some of these countries would be good places for use of the new cervical cancer vaccine. But the vaccine remains quite expensive and still, women need to be checked with an effective cervical cancer test after several years. He says in some places, there are cultural obstacles to providing this test for women. Other places are more open to doing more screening ? but they need better laboratory facilities and more health care personnel.
Obermeyer's paper is published in the online journal PLoS Medicine.