(February 2005) With hundreds of thousands of the world’s women dying of cervical cancer every year, a new report highlights innovative approaches for reducing the impact of this preventable disease—particularly in developing countries, where 83 percent of the world’s new cases and 85 percent of all cervical cancer deaths occur.
In developing countries, women face many barriers to early detection and treatment of the disease—and in many of these countries, cervical cancer is the leading cause of cancer deaths among women, according to the report. Titled Preventing Cervical Cancer Worldwide, the 24-page report highlights research conducted by the five-agency Alliance for Cervical Cancer Prevention (ACCP) on the safety, reliability, and cost-effectiveness of new prevention and treatment techniques.
“Cervical cancer has a major impact on women, particularly women in developing countries,” says Jacqueline Sherris of PATH. PATH is an international nongovernmental organization based in Seattle and one of the ACCP partners working on the new prevention approaches. Sherris adds: “An important reason for the higher incidence in developing countries is the lack of effective screening programs to detect precancerous conditions and treat them before they progress to cancer.”
If it is not detected and treated early, cervical cancer is nearly always fatal. Altogether, the disease kills 274,000 women every year. The regions hardest hit are among the world’s poorest. Central and South America, the Caribbean, sub-Saharan Africa, and parts of Oceania and Asia have the highest incidence rates—over 30 per 100,000 women. These rates compare with no more than 10 per 100,000 women in North America and Europe, according to the report, published by the Population Reference Bureau in collaboration with the ACCP.
Cervical cancer results from the abnormal growth and division of cells at the opening of the uterus or womb—the area known as the cervix. The main underlying cause is the human papillomavirus (HPV), a sexually transmitted infection that is often without symptoms. No cure exists for HPV. And while the infection remains stable or becomes undetectable in most cases, HPV can lead to precancerous conditions that progress to cancer over time.
While women may contract HPV when they are young, cervical cancer is most likely to develop in women 35 years of age or older. Prevention of HPV infection would sharply reduce cervical cancer rates. Therefore, an HPV vaccine, now in the late stages of development, would contribute greatly to preventing new cases of cervical cancer.
Traditionally, global efforts to prevent cervical cancer have focused on screening women for abnormal cervical tissue, treating the condition before it advances, and providing appropriate follow-up care. To date, screening efforts have relied largely on the Pap smear, a test that has long been used to detect abnormal cell changes. However, while the test has achieved tremendous success in industrialized countries that offer periodic, high-quality screening, Pap smear programs are complex and costly to run and have failed to reach a significant proportion of women in countries where health systems and infrastructure are poor.
But cervical cancer can be prevented at low cost. Health providers can use relatively simple technologies to screen women for precancerous conditions and treat abnormal tissue early. The ACCP’s work demonstrates promising approaches that have the potential to reduce the impact of cervical cancer even in the poorest countries.
“The ACCP’s research has found that programs can safely and effectively screen and treat women in just one or two clinic visits, using low-cost techniques,” notes PATH’s Sherris. “In many settings, prevention programs can be integrated into routine health services, assuming adequate resources are available.”
Through its projects in sub-Saharan Africa, Latin America, and South Asia over the past five years and with funding from the Bill & Melinda Gates Foundation, the ACCP has studied screening and treatment approaches—particularly for women in their 30s and 40s.
Research has focused on approaches that markedly increase women’s access to prevention services. Among the most promising alternatives to the Pap smear are visual screening methods that require simple vinegar or iodine solutions and the eye of a trained health provider to spot abnormal tissue. Another alternative involves testing women for HPV on their cervices. While these approaches are still being evaluated, all have the potential to save more lives at lower cost than traditional approaches using Pap smears.
Good prevention programs for cervical cancer share a number of key strategies: They use locally understood messages to increase awareness of the disease; reach a significant proportion of women in their 30s and 40s; motivate women to get tested at least once; make outpatient treatment widely available; and arrange appropriate follow-up care.
Steps to prevent cervical cancer can form part of an overall strategy to improve women’s health and to promote equity and a high quality of care through primary health care systems, says the report.
In addition to PATH, the ACCP comprises EngenderHealth, the International Agency for Research on Cancer, JHPIEGO, and the Pan American Health Organization.