Integrated approaches to women’s cancer improve outcomes

Integrated approaches to women’s care bring together efforts to tackle specific diseases, such as cancer, with wider public health programmes. This helps create consistent and more comprehensive, high-quality services that meet women’s health needs.  

Integrating cancer services for women, such as providing cervical and breast cancer screenings in a single visit, or combining cervical cancer prevention with HPV vaccination programmes or HIV programmes, is an effective means to break down the barriers that prevent women from accessing timely and necessary care. Adding preventive care to existing services also improves outcomes by ensuring women access important preventative care that they may not have actively sought out. 

The publication “Integrated approaches for women’s cancers – opportunities to advance health for women”, launched in September at the World Cancer Congress, is a collection of articles involving some 30 authors, which provides an in-depth look at these approaches. 

The various articles from different regions around the world offer practical examples of how integrated approaches can help to address gaps in service delivery, such as procurement, weaknesses in health systems, the need for greater health awareness and limited resources in terms of healthcare workforce and funding. As such, this publication serves as a valuable resource for policymakers, healthcare providers, and advocates by offering actionable insights to improve cancer care for women worldwide. 

Holistic care models for women’s health are especially beneficial in low- and middle-income countries (LMICs), where healthcare resources are often limited. The integration of breast and cervical cancer screenings has led to increased participation rates and earlier detection of cancers, which not only improves the chances of successful treatment but also reduces the overall burden on healthcare systems. 

"The cancer community has a wealth of experience and numerous examples where integration is common practice. There is limited evidence, however, demonstrating the positive impact of these integrated approaches. This publication addresses this challenge, which hinders the scaling up of effective and efficient solutions and perpetuates siloed approaches to women’s cancer care." 
– Dr Kirstie Graham, Director of Capacity Building, UICC 

Integration in service delivery 

At the service delivery level, integrating cancer care for women offers a pathway to overcoming systemic healthcare barriers.  

The publication highlights successful examples, such as Nicaragua's integration of breast cancer screenings within its cervical cancer programme. This model increases awareness of both diseases, streamlines access, and removes logistical and financial barriers, particularly for underserved populations. 

Another example that is showcased in the publication is the One Stop Women’s Clinic in Zambia, which integrates breast and cervical cancer screenings. This particularly benefits women living with HIV, which is a group at higher risk for cervical cancer. Zambia has also integrated HIV and maternal health programmes, leading to higher uptake rates of cervical cancer screenings. 

The Cameroon Baptist Convention Health Services (CBCHS), a UICC member, significantly improved the acceptability of HPV vaccination through a pilot programme that integrated it with cervical cancer screening. Initially, HPV vaccine uptake in Cameroon was low, with many doses expiring due to vaccine hesitancy and misinformation. In response, CBCHS introduced a mother-daughter programme in rural communities. This integrated approach screened 613 women for cervical cancer and vaccinated 1,892 girls aged 9 to 14. By offering HPV vaccination alongside cervical cancer screening, they saw increased acceptability of the vaccine, as people were more likely to participate in vaccination when it was presented as part of a broader health service.

Joint preventive services are aimed at enhancing early detection and health promotion. The publication calls for health literacy initiatives that empower women, especially in LMICs, to understand the risks, symptoms, and importance of regular screenings, thus improving early diagnosis and adherence to treatment.  

Integration in health systems 

Another important section in the publication is dedicated to the integration of services within health systems. This encompasses governance, workforce development, and financing, and it is crucial for sustaining and scaling comprehensive cancer care. 

The publication points, however, to a lack of guidance on integrating cancer services within national and international strategies. National cancer control plans often overlook integrated approaches, aside from isolated mentions of immunisation and cervical cancer services.  

Yet, civil society organisations (CSOs) have pioneered integration efforts in public education, policy advocacy, and direct service delivery, often bridging the gap where formal policies fall short. In fact, CSOs play a pivotal role in advancing women’s cancer health by combining both breast and cervical cancer services and being agile in adopting women centred care. 

The publication highlights a survey that UICC conducted with its members across Francophone Africa, Latin America, and the Asia-Pacific region. The survey revealed that 86.8% of CSOs reported that their services and activities for breast and cervical cancer are integrated to some extent. 

CSOs are also instrumental in promoting gender-responsive and equitable cancer policies and raising the voices of women affected by cancer. 

The publication further advocates for investments in healthcare infrastructure and the training of healthcare workers, particularly in LMICs. These investments are critical to expanding access to cancer services and ensuring that women receive comprehensive care throughout their cancer journey, from diagnosis to survivorship 

Awareness, access, and equity 

Issues of health awareness, access and equity, as well as comprehensive cancer care and data collection are also key components and of effective service delivery and robust health systems. They are essential to ensuring that an integrated approach to women’s cancer care delivers its potential. 

The publication therefore touches upon improving health literacy to help women understand the importance of prevention, regular screenings, and treatment options, so they actually access the services offered. In low- and middle-income countries (LMICs), a lack of awareness often results in delayed diagnoses and poorer health outcomes. Empowering women with knowledge can be a crucial first step in tackling these challenges. 

To address this, many UICC member organisations are supporting the use of digital tools, such as mobile apps, to provide personalised health information and reminders for screenings. In addition, education programmes and peer support networks play an essential role in increasing awareness. For example, the Singapore Cancer Society runs targeted awareness campaigns on breast, cervical, and ovarian cancers, reaching remote communities through workshops and survivor-led groups. 

Universal health coverage (UHC) and comprehensive cancer care are also included in the publication's recommendations. This means that cancer services encompass diagnosis through survivorship, and cover often-overlooked issues such as fertility, sexuality, and mental well-being with fertility counselling and psychological support to ensure a better quality of life for women after treatment. By integrating these elements into UHC, the goal is to provide inclusive and continuous care that addresses both the physical and emotional aspects of cancer recovery, without the fear of financial hardship.

UHC is also a pathway to improve equitable access to care. Barriers such as poverty, gender inequality, and stigma significantly limit access to necessary healthcare services for women, particularly in LMICs. To address these disparities, the publication emphasises how integrated approaches are cost effective and can generate strong returns on investments, and calls for increased investment in women’s health services within the framework of UHC, alongside the implementation of gender-responsive policies. This ensures that all women, regardless of socioeconomic background, can access the care they need. 

Finally, gathering reliable data, particularly on long-term survival rates and patient follow-up, is essential for guiding better treatment outcomes and shaping future healthcare policies. Tracking referrals and care navigation, developing referral protocols between levels of care, and integrating health records helps ensure timely service delivery, while robust health information systems can enhance the quality of cancer care across regions. This data-driven approach will help policymakers prioritise resources and interventions that can lead to more equitable and effective cancer care for women worldwide.  

Read the publication on Integrated Approaches