New
guidance from WHO on prevention and controlling cervical cancer was launched in
the proclaimed summit on 3 December 2014.
Cervical cancer rates have fallen in
much of the developed world during the past 30 years, largely due to screening
and treatment programs. During the same time, however, rates in most developing
countries have risen or remain unchanged, often due to limited access to health
services, lack of awareness and absence of screening and treatment programs.
Rural and poorer women living in developed countries are at increased risk of
invasive cervical cancer. The new guidance highlights the importance of
addressing gender discrimination and other inequities in relation to a range of
other social factors (such as wealth, class, education, religion and
ethnicity), in the design of health policies and programs.
The main elements in the new
guidance are:
Vaccinate 9
to 13-year-old girls with two doses of HPV vaccine to prevent infection with the
Human papillomavirus (HPV), the virus responsible for most cases of cervical
cancer. The reduced, 2-dose schedule has been shown to be as effective as the
current 3-dose schedule. The change will make it easier to administer the
vaccine. In addition, it reduces the cost, which is particularly important for
low- and middle-income countries where national health budgets are constrained
but where the need for HPV vaccine is the greatest. Today, girls in more than 55
countries are protected by routine administration of HPV vaccine.
Encouragingly, a growing number of low- and middle-income countries are
introducing HPV vaccine in the routine schedule, with support from the GAVI
Alliance.
Use HPV
tests to screen women for cervical cancer prevention. With HPV testing, the frequency
of screening will decrease. Once a woman has been screened negative, she should
not be rescreened for at least 5 years, but should be rescreened within 10.
This represents a major cost saving for health systems, in comparison with
other types of tests.
Communicate
more widely. Instead of
focusing mostly on encouraging the screening of women aged over 29, the guide
recommends communicating with a wider audience: adolescents, parents,
educators, leaders and people working at all levels of the health system, to
reach women throughout their lives.
Dr Nathalie Broutet, a leading
WHO expert on cervical cancer prevention and control, says: “WHO’s updated
cervical cancer guidance can be the difference between life and death for girls
and women worldwide. There are no magic bullets, but the combination of more
effective and affordable tools to prevent and treat cervical cancer will help
release the strain on stretched health budgets, especially in low-income
countries, and contribute drastically to the elimination of cervical cancer.”
An estimated one million-plus
women worldwide are currently living with cervical cancer. Many have no access
to health services for prevention, curative treatment or palliative care.
The guidelines also show how cervical prevention
and control can be integrated into existing health care delivery systems,
including for family planning, postpartum care and HIV/AIDS. The delivery of
vaccinations to adolescents for example, opens the door to reaching them with
additional health information, sexual education and advice about healthy life
styles.
A global opportunity to improve
women’s health: Implementing cervical cancer prevention and control programs
supports the UN Secretary-General’s 2010 Global Strategy for Women’s and Children’s
Health. Cervical cancer was identified in the 2011 Political Declaration of the
High-level Meeting of the UN General Assembly on the Prevention and Control of
Noncommunicable Diseases.
News sources: WHO, UICC, WCC
Dr. Shima Naghavi, Director of
International Affairs