Cervical cancer - way forward


Africa has a high estimated incidence of cervical cancer, thus requiring the development of an effective prevention strategy. Cytology-based screening is beyond the capacity of many African countries, hence the need for alternatives. Visual inspection of the cervix after application of 3-5% acetic acid (VIA) is a promising screening test, with similar sensitivity to that of cytology but lower specificity. The same accounts for other VIA methods using magnification devices, visual inspection after the application of Lugol's iodine, or HPV DNA testing, all proposed alternatives to cervical cancer prevention screening tests. Vaccination against HPV is the most promising strategy for the prevention of cervical cancer, but a wider variety of HPV types than currently being investigated must be considered for the development of the multivalent vaccine preparations required in Africa. Other considerations in developing an effective prevention programme include full public sector investment and achieving acceptability of a vaccine against a sexually transmitted infection targeted for adolescents. Unfortunately, however, if HPV vaccines are developed the initial impact of prophylactic vaccines will be delayed for many years. Alternative strategies should, therefore, be promoted in parallel. There are several approaches to cervical cancer prevention and their evaluation should be comprehensive and coordinated to achieve short and long-term public health benefits in different programme settings.In order to address cervical cancer the issues of challenges the action items below are proposed.

Control of cervical cancer and other cancers affecting women should be carried out within the context of a national cancer control programme and be integrated into existing primary sexual and reproductive health care services. Programmes should aim to create awareness among women aged 30 to 50 years as regards early detection, adequately treat those who have precancerous or invasive lesions and provide palliative care to those with advanced cancer.