By Debbie Saslow, PhD
A lot has happened in the area of cervical cancer this past year. The American Cancer Society, the U.S. Preventive Services Task Force and the American College of Obstetricians and Gynecologists all released virtually identical screening guidelines, leading to less confusion and higher acceptance from health care professionals and the public.
Thanks to screening, cervical cancer is not very common in the U.S., with about 12,340 new cases of invasive cervical cancer expected to be diagnosed in 2013. Unfortunately the same is not true around the world, where more than half a million women are diagnosed with cervical cancer each year. It is actually the 2nd largest cancer killer among women in most low- and middle-income countries.
Sadly, this disease threatens to undermine the important gains worldwide that have been made in sexual and reproductive health, maternal and child health, HIV/AIDs and other infectious diseases. For women in many countries in Africa, Asia, and Latin America, cervical cancer is often detected late, when there is little hope for successful treatment. And it can be devastating to the whole family, both emotionally and financially.
The good news is that a lot has been happening in global cervical cancer. Indeed, many underserved societies have been actively advocating for improved cervical cancer control policies. In response, governments are increasingly making the HPV vaccine available through their health systems and are supporting new cervical cancer screening methods appropriate for their needs and resources.
Rollout of the HPV Vaccine
Just as in the U.S., cervical cancer around the world is highly preventable through screening tests and vaccination against HPV (human papilloma virus, which causes most cases of cervical cancer). If it's found at an early stage, cervical cancer is one of the most successfully treatable cancers.
However, barriers exist in economically developing countries, including access to screening and treatment; the high cost of the vaccines; getting vaccines where they need to go and storing them there; and, significantly, helping educate the public about the safety and effectiveness of vaccinations so that parents will allow their daughters to receive them.
The GAVI Alliance, a partnership of different governments and private organizations, supports the world's poorest countries by making vaccines available at affordable prices. Following the groundbreaking GAVI announcement of including the HPV vaccine in its portfolio (thanks in part to advocacy efforts by the American Cancer Society and the Cervical Cancer Action coalition we co-chair), GAVI is now working with countries, mostly in Africa, to prepare them for introducing the HPV vaccine through national roll out or pilot projects. The pilots aim to build and lay the groundwork to vaccinate girls nationwide. It is anticipated that more than 30 million girls will be immunized by 2020.
The Pan American Health Organization (PAHO) serves countries in Latin America and the Caribbean. Their Revolving Fund for Vaccine Procurement has purchased HPV vaccine in bulk and made the vaccine available to member countries at an affordable price.
For the latest information on the introduction of the HPV vaccine in countries worldwide, see the Cervical Cancer Action Report Card.
Access to New, Improved Screening Test for Low-Resource Settings
Although many low-resource countries don't recommend screening as often as we do in the US, cervical cancer screening tests are an essential part of a woman's routine health care because they can detect cancer or abnormalities that may lead to cancer of the cervix. While vaccines have become an important tool in cervical cancer prevention, effective cervical cancer control also requires women to have access to screening, and for them to actually get screening tests.
Several screening alternatives to Pap tests have been developed that are cheaper or easier to administer in lower resource settings, such as visual screening with acetic acid (VIA) and new HPV DNA tests. One such example is the careHPV test, which is similar to the HPV test used in the U.S. and other wealthy countries, but is designed for low-resource clinical settings, such as areas lacking electricity or water. It is very accurate, reliable, and affordable, and in the coming months the test is expected to be available in China and India, with other countries following suit. Access to low-cost HPV testing in low- and middle-income countries would lead to greatly improved prevention and early detection and has the potential to save hundreds of thousands of lives every year.
A few American Cancer Society Global Health Department collaborations:
The American Cancer Society is committed to fighting cervical cancer and is working tirelessly with countless partners around the globeto save lives from this devastating disease. The American Cancer Society and its Global Health Department has worked with leading cancer advocates in Mexico, Brazil, Kenya and other countries to strengthen policies for access to and quality of cervical cancer control. Currently, the Society is developing a highly innovative collaboration with PAHO and the U.S. Department of Health and Human Services to strengthen comprehensive cervical cancer control efforts in Latin America and the Caribbean.
Cervical cancer is one of the cancers we can impact the most because it is actually preventable. By simply applying what we already know and making that knowledge more available throughout the world, we can make important strides in our mission to prevent suffering and death from cancer across the globe.
Dr. Saslow is the director of breast and gynecologic cancers for the American Cancer Society. She wishes to acknowledge the invaluable assistance of the American Cancer Society Global Health Department on this blog.