Challenges to Cervical Screening in a Developing Country: the Case of Malaysia

Objectives: Many developing countries, including Malaysia, will need to continue relying on cervical screeningbecause they will not be able to cover their entire female adolescent populations with HPV vaccination. The aimof this paper was to establish the extent of the health care, informational, financial and psychosocial barriers tocervical screening in Malaysia.
Methods: A literature search was made for reports on implementation, perceptionsand reception of cervical screening in Malaysia published between January 2000 and September 2008.
Results:Despite offering Pap smears for free since 1995, only 47.3% of Malaysian women have been screened. Severalfactors may have contributed to this. No national call-recall system has been established. Women are informedabout cervical screening primarily through mass media rather than being individually invited. Smears are freeof charge if taken in public hospitals and clinics, but the waiting times are often long. The health care system isunequally dense, with rural states being underserved compared to their urban counterparts. If the screeningcoverage was to increase, a shortage of smear-readers would become increasingly apparent.
Conclusions:Improving screening coverage will remain an important strategy for combating cervical cancer in Malaysia.The focus should be on the policy-making context, improving awareness and the screening infrastructure, andmaking the service better accessible to women.