Why is there CC?
As we know, CC is a preventable disease, and it has been shown that cervical cytology or Pap smear has been decreased the mortality rate of CC in developed countries. Unfortunately, this has not happened in low- and middle-income countries in which almost 9 out of 10 cervical cancer deaths occur, continuing as a priority health problem due to different social and technical factors involved [2].
CC screening program needs to be sufficiently accurate and acceptable for the target population by way of allowing the early detection of the disease and the triage of screen-positive women who requires colposcopy or treatment. To ensure the effectiveness of the screening, it is necessary a coverage rate of at least 80% of the population [2, 17]. Nevertheless, average Pap smear coverage is approximately 18.5% in developing countries, 63% in developed countries and 39.6% across the globe. These percentages could differ in each country but are clear that in any case, the coverage of Pap smear needs to be improved [18].
Pap smear and colposcopy are highly invasive methodologies since they require the introduction of a vaginal speculum to gain access to the cervix, thereby compromising the intimacy of the woman. Most of the screened women suffer shame, pain, inconvenience, or nervousness during the screening procedure, or can experience lower abdominal pain or vaginal bleeding in the days following the test. Women have reported a lack of information before or during gynecological inspections, and sometimes, they have referred a disrespectful attitude and a lack of engagement from the medical staff, resulting on women delaying their gynecological inspection or avoiding it altogether [19].
There are other social aspects interfering with the coverage of Pap screening in the risk population. Inadequate knowledge about the purpose and benefits of Pap smears, the fact that many screened and non-screened women do not know the meaning of an abnormal result.
The fear and anxiety of having cervical abnormalities which affect the future decision to have a Pap test, social and health inequalities between women as a lack of health insurance, faults of organization in health-care programs involving in the appointment scheduling and the long waiting times to get a result, religious beliefs, taboo, fear of stigmatization, etc. [20, 21].There are several technical limitations of the Pap smear screening as the specimen collection that imply collection and processing time, the procedure as the smear is taken, the quality of the samples, processing standards, lack of training of cytotechnologists for the accurate interpretation of results, the loss of concentration and fatigue that suffer by a repetitive task (up to 50 times a day) of visualization of slides. This provokes the rates of false-negative that can conduce to an increase in the cost CC screening and bad prognosis for the patients, as well as, the false-positive results that could cause psychological stress, overdiagnosis and overtreatment [9, 13].
5.