Though preventable, cervical cancer causes half million cases per year

Four volunteers of ICANSERVE Foundation exhort women to take advantage of free cervical and breast cancer screening at an event in the Philippines. Photo: ICANSERVE Foundation

This was originally published on Global Health TV on February 28, 2017.

Over 16 years ago, Sally Kwenda survived colon cancer and HIV, and then lost her husband and two children to AIDS-related illnesses.

Sally Kwenda

“Just when I thought I was done with the hurt and the pain, I was diagnosed with stage II cervical cancer,” she recalls. “Many of those I have met on this journey have either passed away or are worse off than me. Many of them got their diagnoses when it was too late to change the tide. Yet cancer does not have to be a death sentence. My experience reveals that cancer is curable.”

Cervical cancer is the most common cancer among women in Sally’s home country of Kenya as well as in 38 low- and middle-income countries, mainly in sub-Saharan Africa, according to the American Cancer Society (ACS).

The reasons for the high rates of cervical cancer in Kenya, according to Deborah Olwal-Modi, executive director of the Kenya Cancer Association, include lack of knowledge and awareness, inadequate facilities for prevention and treatment, economic barriers, and co-morbidity of cervical cancer and HIV/AIDS. For example, almost all women (97 percent) do not know that a virus causes cervical cancer, according to a new study among women in major Kenyan cities.

Worldwide, there were an estimated 528,000 new cases and 266,000 deaths from cervical cancer in 2012, with more than 86% of those deaths occurring in less developed countries. Last year in India, it killed almost 70,000 women. And the situation is getting worse: The number of deaths is projected to rise to 443,000 annually by 2030, according to the World Health Organization (WHO).

And yet vaccination, early screening and treatment of precancerous lesions can prevent most cases of cervical cancer. In fact, ACS says cervical cancer is one of the most treatable cancers. In the U.S., for example, the cervical cancer death rate has declined by more than 50 percent over the last 30 years.

“HPV vaccination given to adolescent girls and inexpensive screening techniques replacing the too expensive, too complicated Pap smear could bring cervical cancer under control within a generation,” said Sally Cowal, senior vice president of global health at ACS. 

Virtually all cases of cervical cancer are caused by the Human Papillomavirus (HPV) infection through sexual contact, and the optimal time for acquiring infection is shortly after becoming sexually active. That is why the WHO recommends vaccinations for girls aged 9-13 which WHO says is the most cost-effective measure against cervical cancer

Yet some parents seem to have a problem taking their young daughters in for a vaccination against HPV to protect them against infections which may seem far in the future and which is transmitted sexually. In the U.S., a 2014 study published by the U.S. Centers for Disease Control and Prevention showed that only 39.7 percent of girls aged 13-17 had received the full three doses of the HPV vaccine, much lower than the 87.6 percent of boys and girls of the same age that received tenanus-diptheria-acellular pertussis vaccinations.

In a report launched in conjunction with World Cancer Day on Feb. 4, the WHO said that the early diagnosis of cancer and prompt treatment, especially for breast, cervical and colorectal cancers, would lead to more people surviving the disease and cutting treatment costs. “Not only is the cost of treatment much less in cancer’s early stages, but people can continue to work and support their families if they can access effective treatment in time,” said the report.

How much would it cost to implement HPV vaccination in developing countries? Based on a study supported by ACS, Harvard T.H. Chan School of Public Health experts have estimated that approximately 60 million girls in 17 high-burden, low-income countries could be immunized over five years at a cost of approximately $800 million or $13.40 per fully immunized girl. If the U.S. government committed to funding 20% of that, it would equate to about $160 million, or $32 million per year.

But current funding is not well aligned with the actual burden of disease in countries where the U.S. governments supports health programs. “While more than a quarter of deaths in priority low- and middle-income countries is from chronic diseases, such as cancer,” says the ACS, “virtually no funding is provided to prevent those deaths.”

World Cancer Day was Feb. 4 and the theme was “We can. I can” and explores how everyone can do their part to reduce the global burden of cancer.

Certainly Sally Kwenda is playing her part. She is now a Relay for Life “Hero of Hope” (Relay for Life is an annual athletic event to raise funds and awareness for cancer education) with the Kenya Cancer Association and spends her time connecting with other cancer survivors and using the knowledge she has acquired to empower and encourage them.

“The best warrior is not the one who always wins the battle but the one who is not afraid to go back to the battlefield. My plea to every single person is: Now is the time to act. It is time to beat this disease. I strongly believe this is possible.”

The Lancet has just published a special issue on breast and cervical cancer on Feb. 25, 2017.