Cervical Cancer vs. Womankind: Game, Set, Match

A girl in Than Hoa, Vietnam, reads the leaflet provided to her before receiving the cervical cancer vaccine, as her mother anxiously awaits the procedure. © 2010 Amynah Janmohamed, Courtesy of Photoshare.

Receiving a cancer diagnosis is a life-altering experience that can be summed up in one word — fear. Irrespective of an individual’s geographic location, socioeconomic status, gender, education, religion, or ethnicity, cancer provokes this universal response.

Today cancer remains one of the most frightening diagnoses for a patient. This is primarily because even with all the advances in medicine and health care over the last century, when it comes to dealing with most cancers, successful management still seems to boil down to a great degree of luck. Luck that the cancer is identified in time; luck that the cancer is less aggressive than the treatment; luck that an individual even has access to treatment; and luck that one is in the right physical shape to see the fight to the finish.

Indeed luck carries a great deal of weight in beating most cancers, but this should not be the case with cervical cancer – a battle that should be over before it even begins. Cervical cancer is almost exclusively the consequence of long-term infection by two strains of the human papilloma virus (HPV). Modern medicine has provided a safe and effective vaccine that can be administered to adolescent girls and young women, offering them adequate protection before they ever come into contact with HPV. Yet despite this remarkable intervention, the World Health Organization (WHO) and several other sources report that cervical cancer is still the second most-common cancer among women in poor countries; and the fourth most-common cancer among women universally.

Robust screenings, effective treatments, and HPV vaccinations have contributed to cervical cancer rates dropping dramatically in many high-income countries over the past 30 years. Progress has been much slower in low- and middle-income countries (LMICs), which account for more than 90% of the mortality from cervical cancer that occurs today. This huge disparity is mostly  due to competing health demands in the developing world, such as: infectious diseases, WASH, and maternal and child health, which often take priority over cancer and other noncommunicable diseases (NCDs) during budget allocation.

Only 5% of global cancer resources are spent in LMICs; however, current trends make a compelling case for governments in poor countries to increase investments towards the overall management of NCDs. By 2030, NCDs, including cancer, are expected to overtake mortality from infectious diseases in developing countries.

As it stands, the majority of LMICs are ill-prepared and too poorly financed to cope with the heavy burden of cancer that is projected to double every five years due to dramatic changes in lifestyle, increasing urbanization, and aging populations. Poor countries already face severe challenges in managing the existing load of cancer patients today, including: a shortage of specialized health workers and inadequate healthcare infrastructure. This makes preventative measures for highly prevalent malignancies like cervical cancer all the more urgent.

According to Centers for Disease Control and Prevention (CDC), only 67 countries globally had introduced HPV vaccinations in their national immunization programs by October 2016. Coverage rates for most of Southeast Asia and Africa, where the highest prevalence exists, still remain very low. Periodic roll-outs of cervical cancer screening and HPV vaccination campaigns have shown promising results in reaching more women, but it is imperative for governments to establish more routine and consistent access to services by integrating and enhancing HIV/AIDS and family planning programs to include cervical cancer prevention and management efforts.

Several of GHC’s member organizations are at the forefront of implementing sustainable programs for cervical cancer prevention and expansion of screening services. Jhpiego has done tremendous work in Côte  D’Ivoire and Botswana; reaching tens of thousands of women with its low-cost screen-and-treat approach. PATH’s HPV vaccination projects in India, Peru, Vietnam, and Uganda laid the groundwork for effective vaccine introduction and contributed to a decision made by the Vaccine Alliance (GAVI) to subsidize the HPV vaccine for poor countries.

In 2013, GAVI made strong commitments to accelerate HPV vaccine uptake, with the aim of vaccinating over 30 million girls in more than 40 countries by 2020. Vaccinating this large portion of the population will strengthen the immunity of the entire population.

As we commemorate World Cancer Day on February 4, we celebrate the tremendous strides that have been made in tackling cancer globally while also recognizing the work ahead. With more political will, resource mobilization, task-shifting, and collaboration, we have a rare opportunity to take one battle to the finish line. Let’s end cervical cancer for all of womankind!