Determinants of cervical cancer rates in developing countries

Authors

  • Paul K. Drain,

    1. International Health Program, Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA
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  • King K. Holmes,

    1. Center for AIDS and STD, Department of Medicine, University of Washington, Seattle, WA, USA
    2. Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA
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  • James P. Hughes,

    1. Center for AIDS and STD, Department of Medicine, University of Washington, Seattle, WA, USA
    2. Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA
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  • Laura A. Koutsky

    Corresponding author
    1. Center for AIDS and STD, Department of Medicine, University of Washington, Seattle, WA, USA
    2. Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA
    • HPV Research Group, 1914 North 34th Street, Suite 300, Seattle, WA 98103, USA
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    • Fax: +206-616-9788


Abstract

Although cervical cancer (CC) is a leading cause of cancer-related deaths in developing countries, incidence rates vary considerably, ranging from 3 to 61 per 105 females. Identifying determinants of high vs. low rates may suggest population-level prevention strategies. CC rates for 175 countries were obtained from the IARC. Country-specific behavioral, health, economic and demographic measures were obtained from United Nations agencies and other international organizations. Regression analyses performed for 127 low or medium developed countries identified both geography and religion as independently associated with high CC rates. Among behavioral measures, high fertility rates, early age at birth of first child and high teenage birthrates were significantly associated with high CC rates. Countries with high CC rates had fewer doctors per capita, less immunization coverage, more HIV infections and shorter life expectancies. CC rates also tended to be higher in countries with more spending on health and younger, less educated populations. Patterns of CC rates suggest that programmatic approaches, such as promoting delayed childbearing and sexual monogamy, may be appropriate interventions. For countries with high CC rates and some flexibility in their health-care budgets, a once-in-a-lifetime screen of women 30–50 years of age, using Pap smears, direct visual inspection and/or HPV DNA testing, may be cost-effective. Finally, relatively low immunization rates and a shortage of health-care workers in countries with high CC rates suggest potential challenges for introducing prophylactic HPV vaccines. © 2002 Wiley-Liss, Inc.

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