Features and Web Stories

Mar 13, 2007

Getting the word out on prevention

Experts say joint concerted effort by stakeholders could eradicate cervical cancer

Thanks to a new vaccine—the human papillomavirus (HPV) vaccine—cervical cancer is now a fully preventable and curable disease, according to the Pan American Health Organization. Yet more than 86,000 women in Latin America and the Caribbean develop cervical cancer every year, and half of them die from it.

International health experts gathered at the Pan American Health Organization’s (PAHO) headquarters in Washington, DC, on International Women’s Day (March 8^th), to discuss strategies to improve cervical cancer prevention in the region.

Cervical cancer is the second most common type of cancer affecting women in the region overall. In some countries, including Haiti, Nicaragua, Peru and Bolivia, among others, it is the most common cancer to affect women.

Intra-country differences in cervical cancer incidence and survivability in many countries, such as Ecuador, Bolivia, Mexico, Peru and Costa Rica, among others, have been linked to poverty and low education levels.

Experts at the PAHO conference agreed that cervical cancer affects the poor disproportionately, particularly those living in rural areas. “Cervical cancer incidence and mortality are associated with poverty, poor access [to screening, early detection and treatment programs], rural living and low education levels,” said Dr. Merle Lewis of PAHO’s Immunization Unit.

Limited public health resources and competing priorities complicate the picture, as do beliefs and cultural considerations and such limitations as a lack of female health care providers, the cost of getting screened, and a fear of diagnosis because of the belief, widespread in some groups, that cervical cancer automatically means death, Dr. Lewis said.

Two ways that can help women avoid developing cervical cancer include the new HPV vaccine, which prevents the cancer in girls and young women who receive it before the age of 26, and screening for all women, preferably on an annual basis.

“Cervical cancer is fully preventable and curable, at low cost and low risk, when screening of asymptomatic women is available, together with appropriate diagnosis, treatment and follow-up,” confirmed Dr. Lewis. “Yet prevention, screening and early detection programs in Latin America and the Caribbean have met with limited or no success.”

Mexico, for example, has had a screening program in place for 20 years, Dr. Lewis pointed out, but less than 13 percent of the potentially preventable cases have been averted.  Other countries, including Jamaica, Nicaragua and Ecuador, report that less than 30 percent of women who should be getting screened are in fact undergoing the exam, according to PAHO’s 2004 Situational Analysis of Cervical Cancer in Latin America and the Caribbean.

Experts suggested a multi-pronged strategy to step up prevention in the region, and they expressed optimism that cervical cancer could be completely eradicated if the stakeholders—international organizations, national governments, health workers, and women and their families—made a concerted effort toward that end.

“We need to work together to secure a political and economic commitment to fight this very preventable disease,” said Marco Ferroni, Deputy Manager of the IDB’s Sustainable Development Department. “Among the key tasks that we need to focus on right now are introducing the topic of HPV vaccines into our dialogues with country officials in the region and working together to develop vaccine and healthcare delivery strategies that work.”

The IDB’s social development strategy makes clear the Bank’s intent to focus on communicable and infectious diseases, among other aspects of health, Ferroni said, adding that the Bank is “open for business in this area in response to country needs.”  The IDB is already financing one cervical cancer prevention technical cooperation program in Mexico that is helping low-income, rural and indigenous women, in particular.

In addition to vaccine registration and delivery support, Ferroni noted the need to strengthen health information systems and to make available counseling and reproductive education, since HPV, the virus that causes over 70 percent of cervical cancers, is transmitted through sexual contact.

Dr. Anne Schuchat of the US Centers for Disease Control (CDC) agreed that partnerships are vital to eradicating cervical cancer in the region, citing the success of joint efforts in eradicating various diseases in the past. “We need to strengthen partnerships among agencies, between the public and private sector, and between the generations. We can have the same success we had in the past to eradicate diseases like polio, rubella and the measles if we make a huge commitment to the future by vaccinating girls now,” she said.

Jennifer Winkler, program officer at the Program for Appropriate Technology in Health (PATH), emphasized the importance of mobilizing community groups around the topic of cervical cancer prevention. “We [PATH] did a study in Peru that showed that communities with active community promotion teams had higher rates of screening coverage,” she said, “and knowing other women who were screened and having a supportive husband also increased a woman’s likelihood of getting screened.”

Dr. Olivia McDonald, executive director of Jamaica’s National Family Planning Board, suggested that international agencies purchase the vaccine (which currently costs around $300 for the three recommended doses) in bulk for developing countries and provide social marketing support to get the word out.

Also available in: Português, Español