By Edoamaowo Udeme
As January is cervical cancer awareness month, the World Health Organization, (WHO) African Region joins other WHO regions in marking this month to promote the three key messages of this year’s campaign: be informed; get screened; and get vaccinated.
According to a released statement from the Regional Director Dr. Matshidiso Moeti “In 2020, in the WHO African Region, 100,000 women developed cervical cancer and approximately 70,000 of these women died – this is 21% of the cervical cancer mortality globally. Cervical cancer disproportionately affects some of our most vulnerable communities”.
Moeti urged African countries to make use of the key messages of this year’s campaign to first, be informed as it is critical that young women in particular know about the link between cervical cancer and the human papilloma virus (HPV).
“Almost all (99%) of cervical cancer is linked to this common virus, that is transmitted during sex”
“Second, get screened, as knowing about this link with a common viral infection means that it is now easier to screen women for the disease”.
” And third, get vaccinated – this disease can be prevented by vaccinating young women, so preventing HPV infection as Cervical cancer awareness requires us to empower women with knowledge, at school, by clinic staff, and from women who are living with the disease. Understanding the the link between the disease and HPV will encourage screening, and HPV vaccination among young women’
Moeti stressed that the high rates of cervical cancer in our region show that there are major gaps in knowledge, awareness of the disease, and access to screening. “We also need urgently to ensure that the HPV vaccine reaches all our young women between the ages of 9 to 14 years. This requires us to focus on our immediate needs in order to address these gaps”.
On way forward on how the WHO African Region, tackling this unacceptable burden of disease, Moeti said “First, as a region, we have a specific public health framework, launched in 2021, aimed at accelerating the elimination of cervical cancer as a public health problem in Africa”.
“This framework contains concrete actions that can be taken to reach the following targets: 90% of girls are fully vaccinated with HPV vaccine by 15 years of age; 70% of women are screened using a high-performance test by 35 years of age and again by 45 years of age; and 90% of women with pre-cancer are treated, and 90% of women with more advanced cancer are managed”.
“We also need to be aware that women living with HIV have increased susceptibility to HPV infection and so an increased risk of cervical cancer. While this is a particular challenge in the African Region, with our high levels of HIV infection, this is also an opportunity. We can use our HIV screening and treatment services as another opportunity to raise awareness of cervical cancer, and offer screening and vaccination to women attending HIV services”
” We are making good progress in this area, by integrating cervical cancer screening and treatment services into HIV programmes, for example in Zambia, who started this initiative in 2018. Around 235,000 women living with HIV were screened from November 2020 to October 2021. Between 2022 and 2023, there was an increase of 30% in cervical cancer screening rates among women living with HIV” said Moeti.
“HIV services are not the only programmes into which cervical cancer screening and treatment services can be integrated. In 2023, WHO launched a three-year project to integrate breast and cervical cancer services into primary health care services, in Cote d’Ivoire, Kenya and Zimbabwe, targeting more than 300,000 women, for which I need to thank Roche for their support”
Regarding screening, WHO is supporting countries in the region to move towards screening for the presence of HPV as a pointer towards the possible presence of cervical cancer. Sixteen countries are using this technique, and a major breakthrough in screening is the use of self-sampling kits that test for HPV. This can be done at community health centres, as is happening in Kenya, and means that women do not have to travel to larger centres. In addition, in Malawi, for example, the availability of rapid HPV testing at clinics means that women get their test results immediately and be offered rapid and effective intervention, using new, portable devices. Zambia has been able to introduce HPV testing across the country. Cameroon, with support from the Cameroon Baptist Convention Health Services, now uses HPV as primary screening test in 70% of its regions. In addition, WHO enabled Liberia to open their first ever two public sector cervical cancer screening centres.
Countries also need their capacity for early diagnosis and treatment strengthened, and WHO has supported Malawi, Sierra Leone and Zambia by improving training in cervical cancer treatment services. Good pathology services are also needed to diagnose cervical cancer, and once diagnosed patients may need more than one kind of treatment. All of this needs to be scaled up across the region, made available at public health centres, in a way that does not result in major costs to patients and their families.
And now to HPV vaccination – a game-changer in the drive to eliminate cervical cancer, not only in our region, but also globally. We are making major progress in this area. Twenty-seven countries in our region have started HPV vaccination, making it part of routine vaccination in young women. Another move towards accelerating the introduction of the life-saving HPV vaccine, is towards using only one dose – shown to be highly effective, and which means that young women are less likely to drop out of the vaccine schedule. Already, 4 countries have adopted the single dose vaccine. The region overall, is scaling up and increasing HPV vaccine coverage in the target populations, which is highly encouraging.
She urge all countries in the region to actively engage in awareness campaigns, promote screening and encourage HPV vaccination among their young women.
“As we start 2024, let’s keep cervical cancer high on our agenda. My message is clear: first, cervical cancer can be prevented and it can be cured. Everyone needs to be aware of the disease, what causes it and how it can be prevented. Second, there is no one intervention that will achieve this – we need to harness a range of techniques and approaches. Third, the WHO Regional Office for Africa will continue to work with our countries and a range of partners and stakeholders to accelerate action against cervical cancer and ensure that no woman in Africa needs to be diagnosed with this devastating disease”.
