Email this article 
Screening Policy for Early Detection of Cervical Cancer
(1) Universitas Muhammadiyah Surabaya
(2) Universitas Muhammadiyah Surabaya
(3) Universitas Muhammadiyah Surabaya
(*) Corresponding Author
Abstract
Cervical cancer is one of the leading causes of cancer-related deaths among women worldwide. Early detection through effective screening programs has been proven to reduce the incidence and mortality rates of cervical cancer. Objective: This study aims to analyze screening policies for early cervical cancer detection. Methods: A literature review from various references will be used. Results: The findings indicate that the primary screening techniques include cytology tests (Pap smear and liquid-based cytology), visual inspection (VIA and VILI), and HPV-DNA testing. Challenges in implementing screening programs include a lack of trained healthcare personnel, unequal access to services, and low adherence to follow-up for abnormal screening results, particularly in remote and low-income areas. Indonesia has adopted a national strategy aligned with WHO recommendations, encompassing health promotion, pre-cancer screening, appropriate referral pathways, standard facilities and equipment provision, and HPV vaccination policies. Conclusion: This study concludes that comprehensive guidelines are needed to regulate the organization and implementation of screening programs, including recommendations for target age groups, screening intervals, and a sustainable system for evaluation and monitoring to enhance the effectiveness of early cervical cancer detection.
Keywords
Full Text:
PDFReferences
ACOG. (2024, March). Cervical Cancer Screening. ACOG (The American College of Obstetricans and Gynecologist). https://www.acog.org/womens-health/faqs/cervical-cancer-screening
Agosti, J. M., & Goldie, S. J. (2007). Introducing HPV vaccine in developing countries—key challenges and issues. New England Journal of Medicine, 356(19), 1908–1910.
Aklimunnessa, K., Mori, M., Khan, M. M. H., Sakauchi, F., Kubo, T., Fujino, Y., Suzuki, S., Tokudome, S., & Tamakoshi, A. (2006). Effectiveness of cervical cancer screening over cervical cancer mortality among Japanese women. Japanese Journal of Clinical Oncology, 36(8), 511–518.
Anwar, S. L., Tampubolon, G., Van Hemelrijck, M., Hutajulu, S. H., Watkins, J., Wulaningsih, W., & Network, P. R. (2018). Determinants of cancer screening awareness and participation among Indonesian women. BMC Cancer, 18, 1–11.
Aoki, E. S., Yin, R., Li, K., Bhatla, N., Singhal, S., Ocviyanti, D., Saika, K., Suh, M., Kim, M., & Termrungruanglert, W. (2020). National screening programs for cervical cancer in Asian countries. Journal of Gynecologic Oncology, 31(3).
Arbyn, M. , Weiderpass, E. , Bruni, L. , de Sanjosé, S. , & Saraiya, M. ,. (2020). Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. The Lancet Global Health, 8(2), e191-e203. 191–203.
Bartosik, M., Moranova, L., Izadi, N., Strmiskova, J., Sebuyoya, R., Holcakova, J., & Hrstka, R. (2024). Advanced technologies towards improved HPV diagnostics. Journal of Medical Virology, 96(2), e29409.
Bateman, L. B., Blakemore, S., Koneru, A., Mtesigwa, T., McCree, R., Lisovicz, N. F., Aris, E. A., Yuma, S., Mwaiselage, J. D., & Jolly, P. E. (2019). Barriers and facilitators to cervical cancer screening, diagnosis, follow‐up care and treatment: Perspectives of human immunodeficiency virus‐positive women and health care practitioners in Tanzania. The Oncologist, 24(1), 69–75.
Bhatla, N., & Singhal, S. (2020). Primary HPV screening for cervical cancer. Best Practice & Research Clinical Obstetrics & Gynaecology, 65, 98–108.
Blackwell, A. D. (2020). Assessing the Percieved Barriers to Early Detection, Treatment, and Management of Cervical Cancer among Ghanaian Women.
Bosch, F. X., de Sanjosé, S., & Castellsagué, X. (2004). 3. Understanding the origin of cervical cancer. HPV HANDBOOK, 41.
Catarino, R., Petignat, P., Dongui, G., & Vassilakos, P. (2015). Cervical cancer screening in developing countries at a crossroad: Emerging technologies and policy choices. World Journal of Clinical Oncology, 6(6), 281.
Catarino, R., Schäfer, S., Vassilakos, P., Petignat, P., & Arbyn, M. (2018). Accuracy of combinations of visual inspection using acetic acid or lugol iodine to detect cervical precancer: a meta‐analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 125(5), 545–553.
Cubie, H. A., & Campbell, C. (2020). Cervical cancer screening–the challenges of complete pathways of care in low-income countries: focus on Malawi. Women’s Health, 16, 1745506520914804.
Deepa, T. P., & Rao, A. N. (2024). Classification of normal and abnormal overlapped squamous cells in pap smear image. International Journal of System Assurance Engineering and Management, 15(1), 519–531.
Egede, J., Ajah, L., Ibekwe, P., Agwu, U., Nwizu, E., & Iyare, F. (2018). Comparison of the accuracy of papanicolaou test cytology, visual inspection with acetic acid, and visual inspection with lugol iodine in screening for cervical neoplasia in Southeast Nigeria. Journal of Global Oncology, 4, 1–9.
Endarti, D., Kristina, S. A., Farida, M. A., Rahmawanti, Y., & Andriani, T. (2018). Knowledge, perception, and acceptance of HPV vaccination and screening for cervical cancer among women in Yogyakarta Province, Indonesia. Asian Pacific Journal of Cancer Prevention: APJCP, 19(4), 1105.
Fokom Domgue, J., Futuh, B., Ngalla, C., Kakute, P., Manjuh, F., Manga, S., Nulah, K., Welty, E., Schmeler, K., & Welty, T. (2020). Feasibility of a community‐based cervical cancer screening with “test and treat” strategy using self‐sample for an HPV test: Experience from rural Cameroon, Africa. International Journal of Cancer, 147(1), 128–138.
Fontham, E. T. H., Wolf, A. M. D., Church, T. R., Etzioni, R., Flowers, C. R., Herzig, A., Guerra, C. E., Oeffinger, K. C., Shih, Y. T., & Walter, L. C. (2020). Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA: A Cancer Journal for Clinicians, 70(5), 321–346.
GLOBOCAN. (2020). New Cancer Data | UICC Available from: https://www.uicc.org/news/ globocan-2020-new-cancer-data.
Goldie, S. J., Gaffikin, L., Goldhaber-Fiebert, J. D., Gordillo-Tobar, A., Levin, C., Mahé, C., & Wright, T. C. (2005a). Cost-effectiveness of cervical-cancer screening in five developing countries. New England Journal of Medicine, 353(20), 2158–2168.
Goldie, S. J., Gaffikin, L., Goldhaber-Fiebert, J. D., Gordillo-Tobar, A., Levin, C., Mahé, C., & Wright, T. C. (2005b). Cost-effectiveness of cervical-cancer screening in five developing countries. New England Journal of Medicine, 353(20), 2158–2168.
Graham, J. E., & Mishra, A. (2011). Global challenges of implementing human papillomavirus vaccines. International Journal for Equity in Health, 10, 1–11.
Gupta, R., Yadav, R., Sharda, A., Kumar, D., Mehrotra, R., & Gupta, S. (2019). Comparative evaluation of conventional cytology and a low-cost liquid-based cytology technique, EziPREPTM, for cervicovaginal smear reporting: A split sample study. Cytojournal, 16.
Hartmann, K. E., Nanda, K., Hall, S., & Myers, E. (2001). Technologic advances for evaluation of cervical cytology: is newer better? Obstetrical & Gynecological Survey, 56(12), 765–774.
Honarvar, Z., Zarisfi, Z., Salari Sedigh, S., & Masoumi Shahrbabak, M. (2022). Comparison of conventional and liquid-based Pap smear methods in the diagnosis of precancerous cervical lesions. Journal of Obstetrics and Gynaecology, 42(6), 2320–2324.
Hussain, E., Mahanta, L. B., Borah, H., & Das, C. R. (2020). Liquid based-cytology Pap smear dataset for automated multi-class diagnosis of pre-cancerous and cervical cancer lesions. Data in Brief, 30, 105589. https://doi.org/https://doi.org/10.1016/j.dib.2020.105589
IAEA. (2013). Management of Cervical Cancer : Strategies for Limited Resource Centres - A Guide for Radiation Oncologists.
Jeyakumar, A. M., & Mohanapu, S. (2019). A comparison of cervical cancer screening methods: pap smear, liquid based cytology and VIA VILI. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 8(5), 1738–1745.
Kim, Y., Lambe, F. M., Soetikno, D., Wysong, M., Tergas, A. I., Rajbhandari, P., Ati, A., & Lu, E. (2013). Evaluation of a 5‐year cervical cancer prevention project in I ndonesia: opportunities, issues, and challenges. Journal of Obstetrics and Gynaecology Research, 39(6), 1190–1199.
Koliopoulos, G., Nyaga, V. N., Santesso, N., Bryant, A., Martin‐Hirsch, P. P. L., Mustafa, R. A., Schünemann, H., Paraskevaidis, E., & Arbyn, M. (2017). Cytology versus HPV testing for cervical cancer screening in the general population. Cochrane Database of Systematic Reviews, 8.
Kosen, S., Andrijono, A., Ocviyanti, D., & Indriatmi, W. (2017). The cost-effectiveness of quadrivalent human papillomavirus vaccination in Indonesia. Asian Pacific Journal of Cancer Prevention: APJCP, 18(7), 2011.
Landy, R., Pesola, F., Castañón, A., & Sasieni, P. (2016). Impact of cervical screening on cervical cancer mortality: estimation using stage-specific results from a nested case–control study. British Journal of Cancer, 115(9), 1140–1146.
Lazcano-Ponce, E., Lörincz, A. T., Salmerón, J., Fernández, I., Cruz, A., Hernández, P., Mejia, I., & Hernández-Ávila, M. (2010). A pilot study of HPV DNA and cytology testing in 50,159 women in the routine Mexican Social Security Program. Cancer Causes & Control, 21, 1693–1700.
Mahmoodi, P., Fani, M., Rezayi, M., Avan, A., Pasdar, Z., Karimi, E., Amiri, I. S., & Ghayour‐Mobarhan, M. (2019). Early detection of cervical cancer based on high‐risk HPV DNA‐based genosensors: A systematic review. Biofactors, 45(2), 101–117.
Maine, D., Hurlburt, S., & Greeson, D. (2011). Cervical cancer prevention in the 21st century: cost is not the only issue. American Journal of Public Health, 101(9), 1549–1555.
Makde, M. M., & Sathawane, P. (2022). Liquid-based cytology: Technical aspects. Cytojournal, 19.
Menteri Kesehatan Republik Indonesia. (2017). Komite Penanggulangan Kanker Nasional. In Menteri Kesehatan Republik Indonesia. Menteri Kesehatan Republik Indonesia.
Menteri Kesehatan Republik Indonesia. (2021). Program Introduksi Imunisasi Human Papillomavirus Vaccine (HPV) Tahun 2022-2024. In Menteri Kesehatan Republik Indonesia. Menteri Kesehatan Republik Indonesia.
Mwanje, J. (2023). Cervical cancer screening in resource-poor settings of south sudan: access coverage, associated factors and health system interventions.
Nessa, A., Anwar, B. R., & Begum, S. A. (2019). Cervical cancer screening in low-resource settings. Preventive Oncology for the Gynecologist, 167–185.
Nugrahani, R. R., Budihastuti, U. R., & Pamungakasari, E. P. (2017). Health belief model on the factors associated with the use of HPV vaccine for the prevention of cervical cancer among women in Kediri, East Java. Journal of Epidemiology and Public Health, 2(1), 70–81.
Organization, W. H. (2020). Global strategy to accelerate the elimination of cervical cancer as a public health problem. World Health Organization.
Partridge, E. E., Abu-Rustum, N., Campos, S., Fahey, P. J., Greer, B. E., Lele, S. M., Lieberman, R. W., Lipscomb, G. H., Morgan, M., & Nava, M. E. R. (2008a). Cervical cancer screening. Journal of the National Comprehensive Cancer Network: JNCCN, 6(1), 58–82.
Partridge, E. E., Abu-Rustum, N., Campos, S., Fahey, P. J., Greer, B. E., Lele, S. M., Lieberman, R. W., Lipscomb, G. H., Morgan, M., & Nava, M. E. R. (2008b). Cervical cancer screening. Journal of the National Comprehensive Cancer Network: JNCCN, 6(1), 58–82.
Paswan, A., Kumar, A., Jha, K., & Sinha, S. K. (2018). VIA (Visual inspection with acetic acid) and VILI (Visual inspection with lugol’s iodine) as an initial approach with colposcopy as a next screening tool with its positive predictive value in low socioeconomic patients. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 7(1), 210–215.
Pathuthara, S., Dighe, S., Uke, M., Prabhudesai, N., Deodhar, K., & Desai, S. B. (2023). Conventional versus Liquid-based Cytology:“Man versus Machine.” Journal of Cytology, 40(4), 169–176.
Rahmadani, M., Rahayu, N., Fatimah, N., Sulistyani, T., & Windayanti, H. (2023). Dampak Program Pencegahan Penularan Infeksi HIV dari Ibu ke Anak (PPIA). Prosiding Seminar Nasional Dan CFP Kebidanan Universitas Ngudi Waluyo, 2(2), 620–629.
Robbers, G. M. L., Bennett, L. R., Spagnoletti, B. R. M., & Wilopo, S. A. (2021). Facilitators and barriers for the delivery and uptake of cervical cancer screening in Indonesia: a scoping review. Global Health Action, 14(1), 1979280.
Rossi, P. G., & Carozzi, F. (2019). Cervical Cancer: Screening, Vaccination, and Preventive Strategies. In P. Boffetta & P. Hainaut (Eds.), Encyclopedia of Cancer (Third Edition) (pp. 326–344). Academic Press. https://doi.org/https://doi.org/10.1016/B978-0-12-801238-3.65138-3
Sangrajrang, S., Laowahutanont, P., Wongsena, M., Muwonge, R., Karalak, A., Imsamran, W., Senkomago, V., & Sankaranarayanan, R. (2017). Comparative accuracy of Pap smear and HPV screening in Ubon Ratchathani in Thailand. Papillomavirus Research, 3, 30–35.
Sankaranarayanan, R., Gaffikin, L., Jacob, M., Sellors, J., & Robles, S. (2005). A critical assessment of screening methods for cervical neoplasia. International Journal of Gynecology & Obstetrics, 89, S4–S12.
Saraswati, M., Sriatmi, A., & Jati, S. P. (2017). Analisis implementasi program deteksi dini kanker serviks melalui metode inspeksi visual asam asetat (IVA) di puskesmas kota Semarang. Jurnal Kesehatan Masyarakat, 5(4), 85–94.
Satari, H. I., Sundoro, J., Andrijono, A., Hadinegoro, S. R., Syafriyal, S., Tandy, G., & Karolina, S. (2019). Post marketing surveillance study of 2nd dose quadrivalent human papilloma virus vaccine in elementary school children in jakarta, indonesia: safety result and implementation of school-based HPV immunization program. Asian Pacific Journal of Cancer Prevention: APJCP, 20(3), 869.
Selmouni, F., Belakhel, L., Sauvaget, C., Abousselham, L., Lucas, E., Muwonge, R., Sankaranarayanan, R., Khazraji, Y. C., & Basu, P. (2019). Evaluation of the national cervical cancer screening program in Morocco: achievements and challenges. Journal of Medical Screening, 26(3), 162–168.
Setiawan, D., Dolk, F. C., Suwantika, A. A., Westra, T. A., WIlschut, J. C., & Postma, M. J. (2016). Cost-utility analysis of human papillomavirus vaccination and cervical screening on cervical cancer patient in Indonesia. Value in Health Regional Issues, 9, 84–92.
Shastri, S. S., Temin, S., Almonte, M., Basu, P., Campos, N. G., Gravitt, P. E., Gupta, V., Lombe, D. C., Murillo, R., & Nakisige, C. (2022). Secondary prevention of cervical cancer: ASCO resource–stratified guideline update. JCO Global Oncology, 8, e2200217.
Su, S.-Y., Huang, J.-Y., Ho, C.-C., & Liaw, Y.-P. (2013). Evidence for cervical cancer mortality with screening program in Taiwan, 1981–2010: age-period-cohort model. BMC Public Health, 13(1), 1–7.
Thomsen, L. T., Kjær, S. K., Munk, C., Frederiksen, K., Ørnskov, D., & Waldstrøm, M. (2020). Clinical performance of human papillomavirus (HPV) testing versus cytology for cervical cancer screening: results of a large Danish implementation study. Clinical Epidemiology, 203–213.
Universitas Gadjah Mada. (2018). Health Technology Assessment and Pharmacoeconomics Research Center (HTA) (2018) Post-introduction evaluation of HPV vaccine programme in Indonesia. . In Universitas Gadjah Mada. Universitas Gadjah Mada.
Wilopo, S. A., Bennett, L., McPake, B., Dewi, S. M., Halfpapp, A., & Manderson, L. (2023). Rekomendasi atas Implementasi Kebijakan Nasional Pengendalian dan Pencegahan Kanker Serviks di Indonesia. In Universitas Gadjah Mada, University of Melbourne, University of Witwatersrand. Universitas Gadjah Mada.
World Health Organization. (2002). Cervical cancer screening in developing countries : report of a WHO consultation. https://apps.who.int/iris/ handle/10665/42544.
World Health Organization. (2013). WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention (World Health Organization, Ed.). World Health Organization.
Wulan, R., Pawito, P., & Murti, B. (2019). The effect of community health center on visual acetic acid uptake in Pati, Central Java. Journal of Health Promotion and Behavior, 4(3), 189–197.
Article Metrics
Abstract view : 243 timesPDF - 3 times
DOI: https://doi.org/10.26714/jk.14.1.2025.21-31
Refbacks
- There are currently no refbacks.
Copyright (c) 2025 Jurnal Kebidanan
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
JURNAL KEBIDANAN
Program Studi Kebidanan
Fakultas Ilmu Keperawatan dan Kesehatan
Universitas Muhammadiyah Semarang, Indonesia
NRC Building, 2nd FLoor
Jl. Kedungmundu Raya No. 18, Semarang
Tlp. +6224-76740288, Fax. +6224-76740287