The American Society for Clinical Oncology (ASCO) has issued new clinical practice guidelines for invasive cervical cancer. The guidelines are the first to be “resource-stratified,” meaning that they provide specific recommendations based on the availability of health care in different regions.1
According to the guidelines, considerable regional and global disparities in the incidence of and mortality from cervical cancer exist; this is largely due to disparities in access to screening and treatment. The majority of cervical cancer-related deaths — some 87% — occur in less-developed regions. The regions with the highest mortality rates from cervical cancer include Southeast Asia, the Western Pacific, India, and Africa.
Linus Chuang, MD, of the Icahn School of Medicine at Mount Sinai in New York, New York, and Jonathan Berek, of the Stanford University School of Medicine in California, co-chaired the ASCO expert panel that developed the guidelines.
“ASCO uses an evidence-based approach to develop guideline recommendations for the 4 [resource] tier settings,” said Dr Chuang, in an interview with Cancer Therapy Advisor. “This guideline provides alternative options in settings where ideal treatment regimens are not available. It is the view of the authors that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available.”
The ASCO panel, which included experts in cancer control, medical and radiation oncology, health economics, obstetrics, gynecology, and palliative care, reviewed 5 existing sets of guidelines and conducted a systematic review of literature from 1966 to 2015. They developed the new guidelines using a formal consensus-based approach.
The guidelines are organized according to 4 resource settings: basic, limited, enhanced, and maximal. For each setting, they recommend optimal treatment and palliative care for each stage of cervical cancer. Where clinicians are unable to provide the most effective evidence-based interventions due to lower access to resources, the guidelines recommend treatment with “lower-tier modalities, depending on capacity for…care.”
While the guidelines do not directly address cervical cancer prevention and access to cancer screening, two forthcoming ASCO resource-stratified guidelines will.2
“Screening for cervical cancer has been effective in reducing the incidence of and mortality from cervical cancer in developed countries,” Dr Berek told Cancer Therapy Advisor. “Cervical cancer screening with Visual Inspection with Acetic Acid (VIA) holds substantial promise and may replace cytology in lower-income countries. Tests for human papillomavirus (HPV) DNA have shown efficacy as primary screening and, if costs and technology are made affordable, could eventually become the gold standard for these countries.”
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“HPV-related cancers seem to be disproportionately distributed among those of lower income and lower educational attainment and various racial/ethnic groups,” said Dr Berek. “HPV vaccines offer complete protection for HPV-naive girls and young women against the known oncogenic HPV genotypes 16 and 18. [But] in low- and middle-income countries, a primary barrier to HPV vaccination is cost.”
The guidelines addressed the problem of shortages in the availability of radiation therapy equipment and personnel in underserved regions. In some settings, less than 10% of patients have access to radiation therapy.
“There is also a lack of cancer surgical care,” said Dr Chuang. “Five billion people in low-resource settings lack access to safe, affordable surgical care.”
- Chuang L, Temin S, Camacho R, Duenas-Gonzalez A, Feldman S, Gultekin M, et al. Management and care of women with invasive cervical cancer: American Society of Clinical Oncology resource-stratified clinical practice guideline [published online ahead of print May 25, 2016]. J Glob Oncol. doi: 10.1200/JGO.2016.003954.
- New cervical cancer guideline addresses global resource disparities [news release]. Alexandria, VA: American Society of Clinical Oncology; May 25, 2016. https://www.asco.org/about-asco/press-center/news-releases/new-cervical-cancer-guideline-addresses-global-resource.