“I am often asked why I care so much about equality – particularly gender equality. My answer is that I cannot forget the young women and babies who have died in my arms simply because they lived in places where they could not access health services which would have saved their lives. There is nothing worse than holding a dying woman in your arms and thinking: “If we were somewhere else right now, she would have lived.” That was Marleen Temmerman, Director, Department of Reproductive Health and Research World Health Organization in a paper she presented ‘Address inequality: prevent cervical cancer’ as part of the World Cancer Leaders’ Summit in Melbourne, Australia on 3 December 2014.
Cervical cancer is one disease that starkly illustrates the impact of inequality upon women’s health. It occurs worldwide, but most women who die from cervical cancer live in less developed countries. Every year, more than 270 000 women die of cervical cancer, 85% of them in low- and middle-income countries. Inequalities in access exist not only between countries but within them too: in more developed countries, poorer women, particularly those living in rural areas, are less able to access services and are therefore at greater risk.
The paper also highlighted how to address inequities as observed that cervical cancer rates have fallen in much of the developed world during the past 30 years, largely due to screening and treatment programs. During the same time, however, rates in most developing countries have risen or remain unchanged, often due to limited access to health services, lack of awareness and absence of screening and treatment programmes. Rural and poorer women living in developed countries are at increased risk of invasive cervical cancer. The new guidance highlights the importance of addressing gender discrimination and other inequities in relation to a range of other social factors (such as wealth, class, education, religion and ethnicity), in the design of health policies and programmes. “Unless we address gender inequality and ensure women’s right to health, the number of women dying from cervical cancer will continue to rise,” says Dr Marleen Temmerman, Director of WHO’s Department of Reproductive Health and Research.
As part of the World Cancer Leaders’ Summit in Melbourne, Australia on 3 December 2014, a new WHO guide to prevent and control cervical cancer was launched and presented to the international community. A news release shared on that day revealed that cervical cancer is one of the world’s deadliest – but most easily preventable – forms of cancer for women, responsible for more than 270 000 deaths annually, 85% of which occur in developing countries.
The new guidance from WHO aims to help countries better prevent and control cervical cancer. The disease is one of the world’s deadliest – but most easily preventable – forms of cancer for women, responsible for more than 270 000 deaths annually, 85% of which occur in developing countries. The new “Comprehensive cervical cancer control: a guide to essential practice”
The main elements in the new guidance are:
- Vaccinate 9 to 13-year-old girls with two doses of HPV vaccineto prevent infection with the Human papillomavirus (HPV), the virus responsible for most cases of cervical cancer. The reduced, 2-dose schedule has been shown to be as effective as the current 3-dose schedule. The change will make it easier to administer the vaccine. In addition, it reduces the cost, which is particularly important for low- and middle-income countries where national health budgets are constrained.
- Use HPV tests to screen women for cervical cancer prevention.With HPV testing, the frequency of screening will decrease. Once a woman has been screened negative, she should not be rescreened for at least 5 years, but should be rescreened within 10. This represents a major cost saving for health systems, in comparison with other types of tests.
- Communicate more widely.Instead of focusing mostly on encouraging the screening of women aged over 29, the guide recommends communicating with a wider audience: adolescents, parents, educators, leaders and people working at all levels of the health system, to reach women throughout their lives.
Dr Nathalie Broutet, a leading WHO expert on cervical cancer prevention and control, says: “WHO’s updated cervical cancer guidance can be the difference between life and death for girls and women worldwide. There are no magic bullets, but the combination of more effective and affordable tools to prevent and treat cervical cancer will help release the strain on stretched health budgets, especially in low-income countries, and contribute drastically to the elimination of cervical cancer.”
The new WHO guidance provides a comprehensive cervical cancer control and prevention approach for governments and healthcare providers. Also known as the “Pink Book,” it underlines recent developments in technology and strategy for improving women’s access to health services to prevent and control cervical cancer.
It identifies key opportunities as follows;
- Primary prevention: human papillomavirus (HPV) vaccination targets girls aged 9 to 13 years, aiming to reach them before they become sexually active.
- Secondary prevention: access to technology for women over 30 years of age, such as VIA (visual inspection of the cervix with acetic acid) or HPV testing for screening, followed by treatment of detected precancerous lesions, which may develop into cervical cancer.
- Tertiary prevention: access to cancer treatment and management for women of any age, including surgery, chemotherapy and radiotherapy. .
I will conclude by also adding my small voice that we should do what we can within our power and available resources to mitigate the prevalence of cervical cancer in our midst.
This article was 1st published in Daily Trust Newspaper by Dr Aminu Magashi Publisher of Health Reporters (healthweekly@yahoo.com) on Tue, 9th Dec 2014.
