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Eric J. Suba, MD, Sean K. Murphy, MS, Amber D. Donnelly, SCT (ASCP), MPH, Lisa M. Furia, MS, NP, My Linh D. Huynh, MD and Stephen S. Raab, MD

Eric J. Suba is with the Kaiser Permanente Medical Center, South San Francisco, Calif. Sean K. Murphy is with the Valence-point Group, San Jose, Calif. Amber D. Donnelly is with the University of Nebraska Medical Center, Omaha. Lisa M. Furia is with the University of California Medical Center, San Francisco. My Linh D. Huynh is with Brigham and Women’s Hospital, Boston, Mass. Stephen S. Raab is with the University of Pittsburgh Medical Center, Pittsburgh, Pa.

Correspondence: Requests for reprints should be sent to Eric J. Suba, MD, Department of Pathology, Kaiser Permanente Medical Center, 1200 El Camino Real, South San Francisco, CA 94080 (e-mail: eric.suba{at}kp.org).

Papanicolaou screening is feasible anywhere that screening for cervical cancer, the leading cause of cancer-related death among women in developing countries, is appropriate. After documenting that the Vietnam War had contributed to the problem of cervical cancer in Vietnam, we participated in a grassroots effort to establish a nationwide cervical cancer prevention program in that country and performed root cause analyses of program deficiencies.

We found that real-world obstacles to successful cervical cancer prevention in developing countries involve people far more than technology and that such obstacles can be appropriately managed through a systems approach focused on programmatic quality rather than through ideological commitments to technology. A focus on quality satisfies public health goals, whereas a focus on technology is compatible with market forces.

This article has been cited by other articles:

				E. J. Suba, E. S. Cibas, S. S. Raab, J. Ankit, J. Prakriti, K.C. Lakshmaiah, M. L. Cremer, E. Conlisk, J. C. Felix, M. H. Mwanahamuntu, et al. HPV Screening for Cervical Cancer in Rural India N. Engl. J. Med., July 16, 2009; 361(3): 304 - 306. [Full Text] [PDF]

				V. D. Tsu RECONSIDERING THE FEASIBILITY OF PAPANICOLAOU AND ALTERNATIVE SCREENING TESTS FOR LOW-RESOURCE COUNTRIES Am J Public Health, February 1, 2007; 97(2): 199 - 199. [Full Text] [PDF]

				J. Sherris, T. C. Wright Jr, L. Denny, R. Sankaranarayanan, A. E. Pollack, H. Sanghvi, and J. W. Sellors ALLIANCE FOR CERVICAL CANCER PREVENTION: SETTING THE RECORD STRAIGHT Am J Public Health, February 1, 2007; 97(2): 200 - 201. [Full Text] [PDF]

				E. J. Suba SUBA RESPONDS Am J Public Health, February 1, 2007; 97(2): 201 - 202. [Full Text] [PDF]

				E. J. Suba, W. J. Frable, S. S. Raab, and S. J. Goldie Cost-Effectiveness of Cervical-Cancer Screening in Developing Countries N. Engl. J. Med., April 6, 2006; 354(14): 1535 - 1536. [Full Text] [PDF]

				E. J. Suba, K. R. Geisinger, M. A. Zarka, and S. S. Raab Prevention of Cervical Cancer in Low-Resource Settings JAMA, March 15, 2006; 295(11): 1248 - 1249. [Full Text] [PDF]