No Ones Left Behind- Fight Back Cervical Cancer

Cervical Cancer Action (CCA) and its partners are coming together to launch the five-year initiative Taking Cervical Cancer Prevention to Scale: Protecting All Women and Girls. The initiative brings together a multi-sector partnership committed to safeguarding our investments in the health of women and adolescent girls by propelling global cervical cancer prevention forward over the next five years1.

CERVICAL CANCER ACTION INITIATIVE

These issues are addressed with the launch of the Cervical Cancer Action Initiative. It gives you a deep insight in the actual situation of prevention, treatment and cancer plans on the specific topic of cervical cancer.

What it’s all about

Cervical cancer is the No 1 cause of dying in gynecological tumors with a mortality of over 60%2,3. More than 80% of cervical cancer deaths occur in the less developed regions8. Especially in Latin America and Africa cervical cancer is an enormous burden. This is a huge dilemma for mostly younger women are affected, who are mothers, grand-mothers and sisters and often primary-caretakers in their families6,7. Further in low- and middle-income countries due to the lack of prevention and early detection as well as cultural taboos most women are diagnosed in a late and therefore non-curable stage7. This entire still happens, while cervical cancer is one of the most preventable of all cancers5. It is mainly caused by an infection with the Human Papilloma Virus (HPV) for which an effective vaccination exists and, thanks to the enormous engagement like institutions as PAHO (PanAmerican Health Organisation) and GAVI (Global Alliance for Vaccines and Immunisation), is lower priced now than in the beginning. Further there are sufficient early-detection actions like the so called Pap-Smear and with the VIA (visual inspection with acetic acid and cryotherapy) or the HPV-DNA-tests low-cost screening alternatives exists that are better suited for low-resource countries.

Even after diagnose of a pre-cancer-lesion this can be treated successful. While prevention of the infection by using condoms is sufficient in other STIs it’s less effective for protection against HPV infection.7 Therefore, the importance of vaccination and early detection raised but is still to improve in these regions. We all need to ensure now that we get adequate coverage of the vaccine in the countries with the highest incidence. Until today, every year, the suffering and dying of thousands of young women could be prevented. We have the research, tools and experience to make cervical cancer a disease of the past!

Useful resources

To underline the need of action against the burden of cervical cancer please find here some interesting resources in addition, provided by the Union for International Cancer Control (UICC) and their partners to encourage and help people worldwide in this fight.

1. Prevention and Vaccination

Since the first human papillomavirus (HPV) vaccine demonstration project in Kenya in 2013, 300,000 girls have been vaccinated with GAVI support – a figure expected to rise to one million by the end of 2015. See the tremendous effects that the work of GAVI already has had and learn about the challenging goals for 2020: http://www.gavi.org/support/nvs/human-papillomavirus.

PAHO, the PanAmerican Health Organisation provides a bundle of valuable resources in guidelines for screening and treatment in cervical cancer.

RHO Cervical cancer is an online information resource for health program managers and decision-makers working in developing countries and low-resources settings. Get key information about cervical cancer or find background papers and educational materials in the cervical cancer library. Further, find an interactive tool for developing prevention programs for your country in the Cervical Cancer Prevention Action Planner.

In addition, RHO provides the HPVflash, an email news bulletin that disseminates cervical cancer prevention information to interested persons worldwide. If you would like to receive electronic bulletins related to cervical cancer prevention, including HPV vaccines. Please subscribe here to the newsletter.

The  PATH – Vaccine Resource Library  (VRL) collects the top resources on immunisation in one website. The VRL offers high-quality, scientifically accurate materials on specific diseases and topics in immunization addressed by PATH's work.

The Centre for Disease Control (CDC) offers a rich package for clarification and education on prevention and diagnosis on cervical cancer for patients and physicians.

2. Cancer plans / Public Health

For Latin America, cervical cancer is an enormous burden. On eCancer, Guest Editors Dr María Correnti and Dr María Eugenia Cavazza of the Central University of Venezuela, Caracas, Venezuela explain in a special issue the challenge of controlling cervical cancer in Latin America.

RINC – the cervical cancer operating group assists this work in South- and Latin America.

Africa takes up the fight, too. According to WHO statistics, one in 30 women in sub-Saharan Africa will develop cervical cancer and it’s the most common cancer among South African Women. In addition, cervical cancer develops more aggressive in HIV-positive women. While the effect of the HPV-vaccination will work in 10-15 years solutions are needed now. The global “Pink Ribbon and Red Ribbon Initiative” is facing the fight against breast and cervical cancer in countries with limited resources. On their blog you can read among other things more about the way countries like Botswana act: Political Will Backs the Fight against Cervical Cancer in Botswana.

3. Training and Education

Prevention is better than the need of therapy. The most (cost)-effective strategies are those requiring the fewest patient visits. This improves treatment compliance, follow-up and minimises cost. For this the engagement and education of primary health caregivers is essential. So UICC, the International Society of Nurses in Cancer Care (ISNCC) and the Centers for Disease Control and Prevention (CDC) hosted collaborative workshops for nurses and midwives on cervical cancer prevention and screening in San Salvador and Lima in September 2015.

And reach out for a similar project in Myanmar, when UICC supported the Myanmar Ministry of Health and PATH: Cervical Cancer Prevention Training in Myanmar. Focus on visual inspection with acetic acid and cryotherapy.

4. Therapy

Until the effect of vaccination will work therapy will be needed further on. In the first issue of the Journal of Global Oncology, provide by ASCO and UICC, a working group from India describes the challenge of cervical cancer therapy in a developing country: "Concurrent Chemoradiation for Cancer of the Cervix: Results of a Multi-Institutional Study From the Setting of a Developing Country (India)", Nandakumar et al.

5. Deepen your knowledge with some backround-facts

You want to know more about the burden of cervical cancer? The CCA report card contains all the newest information on cervical cancer. Together with the International Agency of Research on cancer (IARC) UICC provides on GLOBOCAN actual data on incidence and mortality of cervical cancer worldwide. See cancer fact sheets on cervical cancer on GLOBOCAN. Get a still actual detailed overview by reading the UICC World Cancer Campaign report 2010 “Protection against cancer-causing infections”.

Literature

1Taking cervical cancer prevention to scale – campaign launch
2 Cancer Incidence and Mortality Worldwide in 2012
3 Cervical Cancer: relevant aspects on prevention, diagnostics and therapy. In: Der Gynaekologe issue 6, 2005, p23-25 
4 How can South Africa fight cervical cancer? – Agenda – The World Economic Forum by Mia Malan
5 http://www.euro.who.int/de/media-centre/sections/press-releases/2011/10/deaths-of-30-000-women-can-be-prevented-whoeurope-calls-for-more-action-on-cervical-cancer
6 http://www.ago-online.de/fileadmin/downloads/stellungnahmen/2009/2009_zervix_epidemiologie_europa.pdf
7 Protection against cancer-causing infections World Cancer Campaign 2010, UICC. Chapter 3 Human papillomavirus and cervical cancer: prevention and treatment with emphasis on low-resource settings 9p 18-24)     
8 http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx