Cancer Prevention Can Be Integrated

· TGI - Biomarkers, TGI - Cancer
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Cancer Prevention Can Be Integrated into HIV, Maternal Health, or Reproductive Health Services

There is growing evidence of the feasibility of integrating cervical cancer prevention into HIV, maternal health, or reproductive health services using low-cost screening strategies coupled with treatment for precancerous lesions.

Conventional screening methods, using Pap smears and biopsies, require infrastructure and clinical expertise and are hard to scale up in LMICs. But simpler, cheaper screening techniques, such as visual inspection with acetic acid (VIA) and human papillomavirus (HPV) DNA testing, hold great promise and are undergoing widespread evaluation.

The World Health Organization global action plan on noncommunicable diseases describes screening with VIA as a “best buy,” meaning that it is both highly cost-effective (i.e., it costs less than the per capita gross domestic product to avert one DALY) and feasible to implement in settings with constrained health systems Integrating screening into primary care services for women should increase the likelihood that precancer is detected, as is seen in high-income countries, where effective screening averts progression to cervical cancer.

Integrating care for HIV, sexual health, reproductive health, and maternal health has been shown to improve uptake of services, reduce HIV-related stigma, and improve the quality of care received by women. A recent study in western Kenya showed that it was feasible to integrate cervical cancer screening into HIV outpatient clinics.

Furthermore, integrating cervical cancer prevention services into primary care facilities provides an opportunity to include and educate male partners, which may be particularly important in regions where men have control over health care decisions.

HPV Vaccination Can Protect Girls from a Fatal Disease

Finally, almost all women with cervical cancer are infected with HPV. The World Health Organization has approved two HPV vaccines that could dramatically reduce cervical cancer deaths in LMICs if vaccination coverage can be scaled up. A recent multinational trial showed that the vaccine can reduce precancerous lesions by up to 90%.

Ensuring that adolescent girls have the opportunity to receive a vaccine that protects them from death, infertility, and other morbidity related to cervical cancer, should be a key global health priority. Vaccination of adolescent girls also provides an opportunity to provide them with other reproductive health services and health education (including education on family planning and menstrual hygiene).

Next Steps

Including cervical cancer in the post-2015 agenda would give the disease the policy priority that it deserves, and could help to attract greater domestic and international donor funding. Lowering the burden of cervical cancer in LMICs will not happen by chance—it requires national and international leadership, attention, and resource mobilization to roll out primary disease prevention through HPV vaccination programs, and secondary prevention through low-cost screening strategies. Rwanda is a good example of how prioritizing cervical cancer at the national level, mobilizing key actors (public, private, and international), and working across multiple sectors (including education) are effective in rolling out HPV vaccination. The country’s national campaign to vaccinate school girls achieved over 90% coverage rates.

Julio Frenk, former Minister of Health of Mexico, and current dean of the Harvard School of Public Health, has argued that the GAVI Alliance‘s decision to include HPV vaccine in its financing portfolio is “a visionary investment that will improve the health of girls and women, equity, and development.”

The GAVI Alliance announced on May 9, 2013, that the world’s poorest countries will be able to obtain, with its support, HPV vaccine for as low as US$4.50 per dose through the United Nations Children’s Fund Supply Division. While this low price is clearly good news, modeling by Goldie and colleagues in 72 countries eligible for this GAVI Alliance–supported program suggested that the intervention would become very cost-effective only at a price of about US$2 per dose. Eventually, we look forward to an era in which all girls and boys are offered the public health benefits of HPV vaccination.The health of women and girls must continue to be prioritized in the post-2015 development agenda. Assuming that the maternal mortality rate continues to fall, we are likely to see a continuing rise in chronic diseases in women in LMICs, including cancers.
Thus, the post-2015 agenda needs to include a concerted global plan to curb the “cancer crisis” of developing countries. For cervical cancer, we fortunately now have a wide range of feasible, affordable, and effective prevention options, which make dramatic global reductions in cervical cancer incidence a realistic goal in our lifetime.Source

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