The case for Investing in Cervical Cancer Prevention

SHERRIS, J., CASTRO, W., LEVIN C., DZUBA, I., ARROSSI, S.

ACCP

Lugar: Seatle; Año: 2004 p. 35

Data from around the world clearly demonstrate that cervical cancer has a disproportionate impact on the health of women in developing countries. According to the most recent information, women in developing countries account for about 85 percent of both the yearly cases of cervical cancer (estimated at 493,000 cases worldwide) and the yearly deaths from cervical cancer (estimated at 273,500 deaths worldwide). Cervical cancer also disproportionately affects the lowest-income women within most developing countries. In the majority of developing countries, cervical cancer remains the number-one cause of cancer-related deaths among women. Cervical cancer represents a unique public health opportunity. Unlike most other cancers, cervical cancer is preventable when precursor lesions are detected and treated before they develop into cancer. The highest-risk lesions—high-grade squamous intraepithelial lesions (HSIL)—are most common among women in their thirties and forties. The cancer that develops when lesions are left untreated is most common among women in their forties and fifties. This distribution reflects the time it takes for HSIL to progress to cancer. If cervical cancer itself is diagnosed in an early stage, it can be cured with the appropriate resources (surgical and radiotherapy services). In many developed countries, the introduction of cytologic screening for early detection of precancerous lesions into stable public health infrastructures and the frequent screening of sexually active women has led to a remarkable reduction in cervical cancer incidence and mortality. Yet, in most developing countries, cervical cancer continues to cause high rates of morbidity and mortality. This inequity between developed and developing countries has three primary sources: 1. The burden of disease from cervical cancer in many developing countries is misunderstood and is often overshadowed by other health priorities, such as AIDS, tuberculosis, and malaria. As a result, health policies to implement effective prevention programs are not in place. 2. Women’s health and the important role developing-country women play in many sectors are often undervalued. 3. Effective new technologies and approaches for screening and treating precancerous lesions in low-resource settings are not well understood, and the costs of launching an effective cervical cancer prevention program are assumed to be out of reach. Cervical Cancer Prevention: Issues in Depth This document provides evidence on the burden of disease and the importance of women’s roles in family and community life to refute the assumptions that underlie the lack of access to cervical cancer prevention services in many developing countries. It also reviews new approaches to cervical cancer prevention in low-resource settings, provides data on cost-effectiveness, and makes the case that, regardless of where they live, women should have access to effective public health programs, which can prevent a significant proportion of cervical cancer deaths. Many of the data on new approaches to cervical cancer prevention in this paper draw on the work of the Alliance for Cervical Cancer Prevention (ACCP). The ACCP has worked to assess innovative approaches to screening and treatment of precancerous lesions in regions where the incidence and mortality are highest.