We Can Eradicate Cervical Cancer Why Haven’t We?

By Merilynn Steenkamp – General Manager, South Africa Multi-Country Network at Roche Diagnostics

Cervical cancer affects millions of lives globally. South Africa alone has a population of approximately 22.2 million women aged 15 and up who are at risk of developing cervical cancer. And according to the HPV Information Centre, over 10,000 women annually are diagnosed with it, while almost 6,000 die from the disease every year. 1

What makes these numbers even more shocking is that cervical cancer – caused by persistent infection with the human papillomavirus (HPV) – can be prevented or treated, provided a vaccine has been administered or the cancer is detected early.

Conversation about cervical cancer is not at the top of many people’s lists of hot discussion topics, but perhaps it should be. It is closer to home than the majority of people might think. HPV is the most common sexually transmitted infection in the world. Globally, both men and women have a 50% risk of being infected with HPV at least once in their life, and the risk is highest in sub-Saharan Africa (SSA), with an average of 24%.

Cervical cancer can affect anyone, regardless of their economic circumstances, and there is no shame in being tested – especially as our primary caregivers are most at risk. In South Africa, at least 92% of primary caretakers of children in poor households are women, including mothers, grandmothers and aunts. Additionally, women constitute over 50% of the South African workforce, so it makes both social and economic sense to protect them.4,5  

The majority of cervical cancer incidence and mortality occur in low- and middle-income countries, many of which are African. This clearly demonstrates the inequities marked by lack of access to national HPV vaccination, cervical screening and treatment services, driven by social, economic, cultural and even personal barriers.2

Traditionally, getting tested for HPV requires a pap smear, performed by a medical practitioner. This procedure can feel invasive, and many women avoid it for that reason. Feelings of embarrassment and, in some cases, cultural bias or stigma prevent women from going for the test. Thankfully, however, testing has evolved, and healthcare facilities can now provide women with self-collection kits. These empower women to collect their own samples and submit them for testing. The convenience and privacy self-collection has created is finally breaking barriers.

Let’s consider a working South African woman – a domestic worker and primary caregiver for her family. She goes to the clinic to have vaccines done for her baby and incidentally, the healthcare worker might suggest a pap smear – the default testing method.

In order to be tested, she would have to take time off work. Arriving at the clinic, she waits to be assisted by a healthcare worker who is tending to over a hundred patients a day, making the experience laborious for both the patient and the healthcare worker. Self-collection addresses this problem twofold. A single healthcare worker can lighten their load by training several women at once to collect their own samples, significantly reducing the burden of time for both patient and healthcare worker.

Every family has a story about cervical cancer. As a child, I remember my mother undergoing a hysterectomy to prevent the onset of cervical cancer. A colleague recently shared her experience, having been diagnosed and having a cancerous lesion removed. Every survivor I have encountered is here as a result of early diagnosis – and living testament to the fact that cervical cancer can be avoided or treated successfully.

Public-private partnerships have made immense progress in eliminating cervical cancer. For example, the Go Further public-private partnership between PEPFAR, the George W. Bush Institute, the Joint United Nations Programme on HIV/AIDS, Merck and Roche is working towards ending AIDS and cervical cancer in Sub-Saharan Africa within a generation, by investing in partner countries to integrate and scale-up cervical cancer screening and treatment. But there is still so much work to be done, as mortality continues to rise across our continent.6

On the cusp of the recent adoption of the WHO Resolution on Strengthening Diagnostics Capacity, we have a framework that governments, policymakers and private sector partners must work towards. The Resolution, while not mandated, acknowledges the value of diagnostics, urging government stakeholders to mobilise and significantly ramp up access to testing.

We have a responsibility to our primary caregivers – mothers, sisters, daughters and partners – to change the statistics. Now is the time for the private and public sectors to come together to eradicate this preventable killer. We need a collective, concentrated effort to establish better testing and HPV vaccination programmes in the highest risk areas.

Cervical cancer can be beaten. Let’s work together to give Africa’s women the lives they deserve.

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