35th National Congress of the South African Society of Obstetricians and Gynaecologists

Abstract

Cervical cancer incidence in Africa in 2008 was equivalent to the incidence in Scandinavian countries prior to the implementation of cytology based screening programmes in the early part of the 20th century. With the introduction of cytology based programmes the incidence of and mortality from cervical cancer fell substantially and today, in well organised screening programmes that function optimally, cervical cancer is a rare disease. SubSaharan Africa has faced many challenges in the past 300 years, not the least being the long term impact of colonialism, systemically racist governments and then post liberation, the legacies of poor governance, lack of financial, human and many other resources. Because cervical cancer is a largely preventable disease, coupled with an awareness that cytology based programmes are hard to initiate, implement or sustain, a concerted effort to find alternative screening tools and approaches has been attempted in the past 15 years. These studies have evaluated a range of alternative screening tests, including visual inspection methods which have involved thousands of women in Africa, Asia and Latin America. These studies have consistently shown the much greater sensitivity of molecular testing with Human papillomavirus (HPV) DNA testing compared to cytology, but with a lower positive predictive value and specificity. However, the near 100% negative predictive value makes it an ideal test for settings where women will be screened, if at all, only once or twice in a lifetime. The most critical factor in setting up secondary prevention for cervical cancer is the creation of an appropriate infrastructure and to provide adequate resources for the programme to function. Primary prevention of cervical cancer through HPV vaccination offers a whole new approach and opportunity to prevent cervical cancer by preventing infection with high risk types of HPV, known to be aetiologically associated with cervical cancer. However, implementing HPV vaccination is a relatively complex process in countries that lack immunisation programmes for adolescent/pubescent children. Vaccination though has proved to be a very successful public health intervention and with the pressure of the Millennium Development Goals, population coverage with other types of vaccines has improved significantly in developing countries, reaching over 90% in many areas. Can cervical cancer be prevented in Africa? Yes it can, but whether resources will be allocated to these programmes will ultimately be decided by those in control of resources (usually politicians). A commitment and realisation from the governments of Africa that investing in the health of their women is cost-effective, reduces poverty, and uplifts the growth of nations at all levels. The MDGs have made women’s health a priority. Cervical cancer fits into this paradigm.