Expanding care for women’s cancers in low-resource settings

Breast cancer and cervical cancer together account for almost one third of all new cases of cancer for women, and almost one quarter of cancer-related deaths. For this reason, both cancers are key areas of work for UICC, aligned with and supporting WHO’s efforts, with the global commitment to eliminate cervical cancer in 2020 and the launch of the Global Breast Cancer Initiative in 2021.

The roadmap to significantly reducing breast and cervical cancer-related mortality is clear: both cancers can be treated with a high degree of success when detected early through routine screening, and cervical cancer can mostly be prevented through HPV vaccination. In low- and middle-income countries, however, populations lack access to these life-saving services as well as to adequate health education and awareness of cancer risks. As a result, some 90% of deaths due to cervical cancer and 68% of deaths due to breast cancer occur in LMICs. 

At a recent workshop led by UICC in partnership with the French National Cancer Institute (INCa) titled “Towards integrated and collaborative approaches for women’s cancers in Francophone Africa”, participants cited as the primary challenges a lack of resources and data as well as weak monitoring systems and health infrastructure.

UICC recently partnered with the organisation Thinkwell to explore how to mobilise existing resources and mechanisms to address these challenges and reduce the burden of women’s cancers in Francophone Africa. This project built on previous work conducted by Thinkwell on a series of country profiles on financing cervical cancer elimination in the context of the SUCCESS project, including for Burkina Faso and Côte d'Ivoire.

As a result, a methodology was developed on how partnerships and integrated approaches could be built at the national and regional levels, and presented at the event on reducing the burden of women’s cancers in Francophone Africa by Marie-Jeanne Offosse, Country Director for Burkina Faso at Thinkwell and health economist. 

The methodology looks at how public health authorities, cancer advocates and civil society can work together and leverage existing financing mechanisms to integrate comprehensive women’s cancers into current health programmes. Mechanisms include pooled procurement for medicines, mobilising resources used for other diseases such as tuberculosis or HIV/AIDS, harnessing new diagnostic technologies from COVID-19 (e.g. for HPV vaccination and testing), strengthening cancer registries and expanding UHC to cover essential cancer services. 

In an interview with UICC, Ms Offosse explains in further detail how this methodology can be implemented to achieve integrated care and overcome current barriers to comprehensive cancer care and financing challenges.

Ms Offosse, what are the key elements of your approach to financing care for female cancers in low-resource settings?

There are two essential pillars: financing and efficiency. What resources does a country have at its disposable to fight its national cancer burden – and how can they be used most effectively to achieve the objective of reducing the number of preventable deaths. 

When I say “available resources”, this does not mean only for cancer care or women’s health in particular, but within the entire health system. This is where we can achieve integration. For instance, if a country has well-developed systems for screening for other diseases such as tuberculosis or treating HIV, then these could be used to test women or vaccinate against HPV at the same time.

Integration not only concerns medical equipment and technology but also encompasses community outreach and awareness raising. Why not use the resources mobilised to fight COVID-19, for instance, to inform people about cancer? 

What are some examples of financing mechanisms that can be used for cancer control?

Financial toxicity – where patients fall into poverty or further into poverty because they have to cover cancer-related medical expenses out-of-pocket – is a real issue. These costs need to be covered by the health system. 

Burkina Faso, for example, introduced free health coverage in 2016 for children under five and for reproductive care, which includes breast and cervical cancer screening.

This does not involve a significant additional financial burden to the State, and it makes economic sense to invest in prevention and save lives – it is less costly in the long-term to public health and social welfare than allowing people to die of a preventable disease. 

Could this be a way to move closer to Universal Health Coverage?

Absolutely. More and more countries in Sub-Saharan Africa are adopting some form of universal health insurance. The key point here is that cancer services need to be included so that the costs for care can be mutualised. When the risks are shared between millions of people, the financial burden for each person when they fall ill is far less.

Access to services is not only about making them available and affordable. There are also other barriers, such as living far from a care centre or the inability to take time off work, that can effectively prevent someone from consulting a doctor or pursuing treatment. Mechanisms exist that can help overcome these barriers to care must also be used for cancer patients.

Indeed, we need healthcare that places people at the centre. Integration must not be limited just to the health sector, but must also encompass everything that is connected to social welfare and education. People working in the cancer space need to connect and work with those in other sectors, so that we don’t look at issues of cancer screening, detection and treatment without considering the wider economic and social impact of care. The fact that a woman can receive a timely diagnosis and treatment for her cancer won’t matter if she can’t put food on her table or care for her children.

How can partnerships and integrated care also address cultural barriers, such as gender norms or stigma?

Women empowerment projects, for instance, now often reach out to men to inform them about family planning and contraception. It would only take ten more minutes to explain to them the importance for women to screen for cancer, and overcome the taboo surrounding female cancers, which generally involve an examination of the sexual organs. 

This is particularly essential in places where women still need approval from their husbands or fathers to consult a doctor, especially with respect to such a taboo subject as female cancers that involve sexual organs. Also because women with breast or cervical cancer often face rejection from their husbands and families.

Again, it’s quite straightforward to set up, because NGOs are usually the ones carrying out these awareness campaigns and their staff are well qualified. It’s worth investing in a "cancer module" and adding a section on cancer in training manuals.

The same applies to using existing resources aimed at fighting misinformation around the COVID-19 vaccine to fight similar misconceptions about the HPV vaccine.

Who was the methodology designed for – governments?

Yes, governments of course, but also NGOs that support governments in designing policy, projects or funding requests.

Ideally, it should be adopted within a multi-sectoral team so that they collaborate in a participatory manner and look at all aspects of an issue – in a particular national context. This way, you don’t have, for instance, a team focused on the best means to prevent cancer without looking at how to finance it.

Finally, it’s a methodology that can be used in different contexts by other countries. There are no fixed or imposed solutions. It’s a “bottom-up” approach, where countries evaluate their specific needs, resources and opportunities.

UICC will continue to convene interested parties on the topic of expanding care for women's cancers at a Regional Dialogue in Abidjan, 12-13 July 2022. The World Cancer Congress in Geneva on 18-20 October will also have several sessions dedicated to women's cancers and the theme of equity in healthcare.