CERVICAL CANCER is a leading cause of death in lower-income countries. Today, approximately 90% of the world's cervical cancer deaths occur among women in lower-income countries.
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Pap screening prevents cervical cancer by detecting and eradicating pre-cancerous cervical lesions before they progress to life-threatening cervical cancers. The US Preventive Services Task Force has determined that Pap screening reduces cervical cancer rates by 60% to 90% within 3 years of implementation, and that these reductions in suffering and premature death are "consistent and dramatic​ across populations."
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The Head of Cancer Screening at the World Health Organization has emphasized that "good-quality Pap screening can be implemented even in a rural setting of a lower-income country with reasonable investment."
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Pap screening in lower-income countries is a moral imperative because saving as many lives as quickly as possible is a moral imperative. However, moral imperatives lack relevance if they are not supported by sufficient political will.​
 
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FOUR TECHNOLOGIES prevent cervical cancer: Pap screening, visual screening, human papillomavirus (HPV) screening, and HPV vaccination.
 
Chronic infection of the cervix by HPV, which is sexually acquired, causes cervical cancer. Nearly everyone will get HPV at some point in their lives. HPV vaccination is recommended for girls because it does not prevent cervical cancer among women who have previously gotten HPV. Therefore, HPV vaccination does not offer protection against cervical cancer for most women in lower-income countries. Pap screening can offer protection for all women in lower-income countries.
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HPV vaccination, if implemented without cervical screening, will require decades to reduce cervical cancer rates by 50%. In contrast, the US Preventive Services Task Force has determined that Pap screening reduces cervical cancer rates by 60% to 90% within 3 years. HPV vaccine expert Diane Harper observes “Combining cervical screening with HPV vaccination does not significantly lower the number of women getting cervical cancer every year, but does decrease the number of women with abnormal screening tests.”
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HPV tests cannot be used to screen women under the age of 30, due to unacceptably high false-positive rates of HPV tests among younger women. Visual screening tests cannot be used to screen older women, due to anatomical changes that occur in the cervix as a woman approaches menopause.​ Pap screening protects women of all ages from developing cervical cancer.
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Even in expert hands, quality control for visual screening has failed catastrophically. HPV screening, which remains too expensive for routine implementation in lower-income countries, requires a pre-existing Pap screening infrastructure and can readily be phased in to pre-existing Pap screening programs should prices for HPV tests fall into an affordable range.
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If our objective is to honor the moral imperative of saving as many lives as quickly as possible, then Pap smear screening is the appropriate technology to promote for cervical cancer prevention in lower-income countries. Competing imperatives -- such as corporate profit-making, non-profit corporate fundraising, and academic advancement -- involve promoting technologies other than Pap screening for lower-income countries.
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WE LEARNED in 1994 that the burden of cervical cancer in Vietnam was a legacy of the Vietnam War. That knowledge generated sufficient political will to honor the moral imperative of saving as many lives as quickly as possible. Working as unpaid volunteers, we subsequently participated in the establishment of Pap screening in southern Vietnam, which led to 50% reductions in cervical cancer rates between 1998 and 2003. We delayed publication of data linking war to disease until 2004 in an attempt to ease the process of reconciliation by presenting what most would acknowledge to be a remedy in advance of what some would perceive to be an accusation.
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At the start of the 21st Century, Vietnam had provided a model for successful cervical cancer prevention in lower-income countries. Vietnamese and American colleagues were preparing to replicate Vietnam's success by, together, implementing Pap screening in other lower-income countries.
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UNFORTUNATELY, since the start of the 21st Century, two developments have decimated political will for the moral imperative of Pap screening in lower-income countries:
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1. In 1997, the US National Institutes of Health (NIH) launched an experiment in Mumbai that contributed to the preventable cervical cancer deaths of at least 500,000 Indian women. As part of the cover-up of that catastrophe, NIH-funded physicians have broadcast the unfortunate falsehood that Pap screening is not feasible in lower-income countries. 
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2. In 1999, the Bill & Melinda Gates Foundation established the Alliance for Cervical Cancer Prevention. The non-transparent and incorrect founding assumption of the Alliance was that novel technology, instead of Pap screening, was the most likely solution for cervical cancer in lower-income countries. That unfortunate assumption has corrupted medical science and decimated political will for Pap screening in lower-income countries. In 2002, the Alliance formally dismissed our suggestion that Pap screening be implemented in lower-income countries.
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Because of NIH and the Gates Foundation, one of the world's big, fixable problems is being fixed far too slowly -- with catastrophic, lethal consequences .
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THE GOAL of this website is to avert further human catastrophe by encouraging NIH leaders to start telling the truth.
 
Eric J Suba MD
President and Executive Director
The Global Cervical Cancer Prevention Project
(formerly named The Viet/American Cervical Cancer Prevention Project)