The Winnable Fight against Cervical Cancer
Cervical cancer is the leading cause of cancer death for women in 40 of the 48 countries of sub-Saharan Africa. The good news is that unlike many cancers, most cervical cancers are preventable with regular screenings known as pap smears for early detection and vaccines to prevent the human papillomavirus virus (HPV), a leading cause of cervical cancer. Yet cervical cancer still claims more than 270,000 women’s lives annually.
Unsurprisingly, the burden of this disease falls disproportionately on women in developing countries. While cervical cancer rates have fallen in much of the developed world during the past 30 years, rates in most developing countries have risen or remained unchanged. In a just world, where you live should not determine whether or not you have access to basic health care.
My home country, Zambia, is ranked among the top five countries in cervical cancer incidence and mortality globally and 16 of the 20 countries with the highest incidence of cervical cancer are in Africa, according to the World Health Organization (WHO). These deaths can be averted if only all women had access to simple screening and prevention methods.
Simple and affordable screening techniques could revolutionize prevention, diagnosis and treatment of cervical cancer. In low resource settings, you don’t need fancy medical equipment to screen for cervical cancer. A simple test that uses household vinegar, also known as visual inspection with acetic acid (VIA), exists and could be implemented by doctors, nurses and community health workers with proper training.
Visual inspection with vinegar can be done with the naked eye or with a simple microscope. VIA involves performing a vaginal speculum exam during which a health care provider applies vinegar to the cervix. If tissue is abnormal, it temporarily appears white when exposed to vinegar. This enables the provider to determine whether the test result is positive or negative for possible precancerous lesions or cancer.
VIA could be a game-changer because it is a simple, easy-to-learn approach that is minimally reliant upon infrastructure. The start-up and sustaining costs are not prohibitive. Additionally, many types of health care providers can perform the procedure and administer treatment immediately in the case of a positive result.
Another prevention tool against cervical cancer is the HPV vaccine. The WHO recommends 9 to 13-year-old girls receive two doses of the vaccine to prevent HPV infection, the primary cause of cervical cancer. A recent study by the Center for Disease Control shows that the vaccine is more efficacious in reducing HPV infection in teenage girls than previously thought. Yet in countries like mine, such vaccines have not been available for a long time due to market failure. The profit-driven pharmaceutical industry has little to no incentive for producing vaccines for clients who can’t pay.
Lack of tools and technologies to prevent cervical cancer are common problems for a number of countries where there is weak public health infrastructure. Research supported by the Bill and Melinda Gates Foundation emphasizes that cervical cancer prevention program success depends on robust public health infrastructure that can systematically promote the full-range of best health outcomes.
Although robust public health infrastructure sounds like an expensive and complex undertaking for the developing world, the advent of low-cost and low-tech interventions such as Screen-and-Treat make the goal of an effective screening regime achievable.
It is an affront to our collective conscience that a disease that is highly preventable through effective screening programs and a vaccine treatment continues to kill this many women. It simply doesn’t have to be this way when we have the modern medical interventions and solutions to better serve and empower women.
Dr Marleen Temmerman, Director of WHO’s Department of Reproductive Health and Research aptly reminds us that “unless we address gender inequality and ensure women’s right to health, the number of women dying from cervical cancer will continue to rise.”
Suwilanji (Stukie) Situmbeko is a 2015–2016 Global Health Corps fellow at Planned Parenthood Global in New York City and tweets at @Docstukie. All GHC fellows, partners and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. Join the movement today.