Tackling a Disease of Inequity

Dr. Heather White, PSI Senior Technical Advisor for Non-communicable Diseases

Each year, an estimated 528,000 women develop cervical cancer, and roughly 266,000 women die of the disease. Almost 90% of these deaths occur in low- and middle-income countries (LMICs). Put simply, cervical cancer is a disease of inequity.

While the US and other developed nations have seen dramatic declines in cervical cancer rates due to widespread cervical screening programs and, more recently, availability of the HPV vaccine, this is not a universal trend.  Cervical cancer mortality has eclipsed other leading causes of death of women in LMICs, including pregnancy-related deaths, largely due to limited availability of screening and treatment services. In countries with high HIV rates, cervical cancer is even more common, and is often the leading female cancer. Without decisive commitment and action, annual deaths due to cervical cancer are estimated to rise to more than 710,000 by 2030.

The American Cancer Society’s (ACS) Cancer Action Network recently hosted a briefing on Capitol Hill to share the latest updates and evidence in cervical cancer prevention and insights from existing global programs, with invited panelists from PSI, PATH, and IMA World Health.

Sally Cowal, Senior Vice President, Global Cancer Control at ACS, kicked off the event by acknowledging the US government’s ongoing support to programs supporting cervical cancer prevention, including GAVI and PEPFAR. Ambassador Cowal further called upon the country to increase its contributions and serve as a global leader in ending preventable deaths due to cervical cancer. Representatives Debbie Wasserman Schultz and Nita Lowey spoke in support of the plea, while other members of Congress and their staff also attended the session.

I shared evidence from PSI’s cervical cancer ‘screen and treat’ program, implemented in Uganda through PSI’s local network member, PACE. In 2013, once we introduced cervical cancer screening in our clinics, uptake of both cervical cancer and family planning services increased considerably. When we analyzed these trends more recently, we found that they largely held up over time. In 2016, over 54% of women who visited Uganda’s ProFam network took up both family planning and cervical cancer screening services. This is a great example of complementary services that can be easily integrated in a single clinic, and often in a single visit.

Vivien Tsu, PATH’s associate director of reproductive highlighted a recent supplement from the International Journal of Gynecology & Obstetrics, which highlights recent progress and outlines the unfinished agenda for cervical cancer prevention in low-resource settings.

Gloria Nantulya shared stories from IMA World Health. The faith-based organization supports local partners in Tanzania that perform on a volunteer basis and provide services at no charge — an approach for which adequate financial support is an ongoing challenge. “What is frustrating is that we have all of the tools we need to prevent this disease, and yet women continue to die from it,” said Ms. Nantulya.

There are plenty of reasons to be optimistic (even impatient!) about cervical cancer. The global health community has proven, effective, and inexpensive tools to end deaths from cervical cancer worldwide. While technology will continue to improve existing tools, the question before us is how to best deploy our tools and resources to reach the largest number of girls and women at risk for cervical cancer. To meet the increased global demand for vaccine, screening, and treatment over the next decade, we need increased political support and commitment for this work.

We can prevent cervical cancer, and with political will and the support of both national and global partners, we will.

To help prevent cervical cancer, tweet this call to action: http://bit.ly/2xKUm9Z

More information on PSI’s cervical cancer programs is available here.