World Cancer Day 2015: Addressing Global Cervical Cancer: Not Beyond Us

Not Beyond Us. This is the theme of World Cancer Day 2015. But how will we achieve it? Cancer can seem insurmountable. The global cancer burden is great. In 2012, 8.2 million people died from cancer-related causes—most of them in Africa, Asia, and Central and South America, which experiences more cases and more deaths than anywhere else: 60 percent of the 14 million new cancer cases annually and 70 percent of all cancer-related deaths occur in the developing world. The same countries bearing the brunt of the cancer burden have the fewest resources to tackle it.

Still we know and remind one another today, the 4th of February: We can and must stop vaccine-preventable cancers and reduce preventable cancer deaths. We must reduce the cancer inequities.

Cancer, you are not beyond us.

Among women, cervical cancer is one of the deadliest -- and most easily preventable -- cancers. Women in the developing world account for 85 percent of the 270,000 deaths every year. Yet we know that effective prevention, treatment and care are possible.

Cervical cancer can affect a woman at any stage of life—from early adolescence through advanced age. By working together for an integrated response we can ensure a girl is vaccinated; an expecting mother is screened; and a cancer patient receives the care she needs. For some women and girls, cervical cancer is a more-feared diagnosis than HIV (Watch: Mildred's story). But, Management Sciences for Health (MSH) and others are seeing successes in early detection by integrating screening with other health services.

Integrating screening with other health services (e.g. HIV, family planning) and community outreach

Increasingly, cervical cancer is being incorporated into routine care and other health promotion activities. This is essential: cervical cancer care involves communities, local health facilities, district hospitals, and ministries of health. Integrated care means national governments, health managers, local leaders, community health workers, academia and civil society coming together to save lives.

Community health workers play a vital role in identifying and referring women in underserved areas for screening.

In much of Uganda, MSH has been working with partners to integrate cervical cancer screening with family planning and HIV care in health facilities. HIV-positive women, whose immune systems are suppressed, are more likely to become infected with the human papillomavirus that causes cervical cancer. Early detection through screening reduces the chance of developing and dying from cervical cancer. Through the United States Agency for International Development (USAID)-funded Strengthening TB and AIDS Response – Eastern Region (STAR-E) project, MSH and partners worked with Mbale Regional Referral Hospital in Eastern Uganda to screen HIV patients, and treat those at risk for cervical cancer (watch video).

Integrating screening for chronic diseases in conjunction with outreach during internationally recognized commemorative days has also been successful for MSH through STAR-E. In 2014, the project conducted screenings on World Cancer Day at at a health center and a resource center, targeting commercial sex workers and the general population. Jennifer Acio, gender and people living with HIV advisor for STAR-E, says:

At both sites, the outreach began with educating mothers about cervical cancer, emphasizing the importance of screening, risk factors, and where to access services. Health workers offered counseling before the actual screening. Both sites also offered screening for sexually transmitted infections.

Early detection "saved my life"

Women wait outside the Miritini cervical cancer screening room.Photo credit: LMS/Kenya

A similar effort to integrate cervical cancer care with routine services has been successful in Kenya. Kenya’s national health policy mandates the integration of health services for HIV & AIDS, family planning and cancer. The Miritini Dispensary, for example, provides essential health services, as well as HIV & AIDS, tuberculosis and maternal and child health care. The USAID-funded Leadership, Management and Sustainability (LMS/Kenya) program, led by MSH, helped Miritini to expand cervical cancer screening. Says one beneficiary of a cervical screening service at Miritini Dispensary in Kenya:

As a result of the screening, I was able to discover my status early enough and seek proper medical intervention. If I had not gone through the screening, I may never have discovered this early enough, and perhaps might have died out of complications. Miritini saved my life.

In just six months, Miritini increased the number of women screened for cervical cancer as part of routine care 20-fold (Read case study).

Cervical cancer, you are not beyond us.

Not Beyond Us

The World Cancer Declaration“calls upon government leaders and health policymakers to significantly reduce the global cancer burden, promote greater equity, and integrate cancer control into the world health and development agenda.” This means we must help communities, facilities, cities, and countries to lead on addressing cancers and reaching the targets by 2025.

Not Beyond Us means empowering women and girls to make healthy life choices. Not Beyond Us means detecting cervical cancers early: screening and diagnosis for all women and girls. Not Beyond Us means treatment for all diagnosed, which will only be achieved through universal health coverage. Not Beyond Us means ensuring quality of life, including palliative care.

The urgency is great. To reduce preventable deaths from cervical cancers and close the global cancer divide, address cancers at all levels of the health system. From national guidelines that help prevent HPV in young girls, to integrated screening programs linked with family planning services, and community outreach to identify women at risk, a coordinated response can prevent and control cervical cancer.

Addressing the global cancer burden, and specifically, the global cervical cancer burden, is not without its challenges. It takes many partners, but it is possible. We can turn challenges into opportunities and ensure that services for cervical cancer are part of routine health. To be sure, in every part of the health system and at every stage of life, in the emerging cities and the far-reaching rural communities, improving the health of women and girls is not beyond us.

Addressing global cervical cancer is within reach.