Cervical cancer kills over four thousand women a year. Staggeringly, it has been estimated that up to 93 percent of cases could be prevented by screening and vaccination against Human Papilloma Virus (HPV), the virus known to be a cause of cervical cancer.
HPV causes warts, which mostly occur on the hands and feet. However, certain strains also affect the genitals. Although most warts are non-cancerous, some strains of HPV are strongly linked to cervical cancer.
Despite advances in prevention and control, cervical cancer remains the second most common cause of death from cancer in women. The vast majority of those deaths occur in countries that fall within the World Bank definitions of low- and middle-income countries.
Today is World Cancer Day, and it is now more important than ever to raise awareness of the issues surrounding cancer across the world, assess the progress we have made, and look at how far we have yet to go before we can declare cancer beat.
The Pulse spoke with Dr. Phil Castle, the Executive Director of Global Cancer Initiative, and the Executive Director of the Global Coalition against Cervical Cancer, also known as GC3. He hopes to introduce cervical cancer prevention programs in countries where constrained resources do not allow the same level of care that benefits millions of women in higher-income countries.
“Essentially, there is not a single organization that has the manpower or the knowledge to provide a sort of ‘one-stop shop’ for a country that wants to implement a [cervical cancer screening] program,” said Dr. Castle.
“The idea was to create a platform on which different groups could be called upon to work together, for those countries really committed to moving forward. So it’s a little different than the one-off activity in which a doctor might to a country and do screening, or provide services for three weeks and then go home,” he added. “The goal here is to provide sustainable support. To basically help a country make an informed decision about what they should do, how they should do it, and provide the training and education that they need to implement it themselves.”
In what appears to be a David versus Goliath scenario, there are many barriers to overcome before cervical cancer screening can be effectively implemented across lower-income countries. These are namely cost, compliance (from governments as well as patients), and the level of expertise that may be needed to properly carry out screening procedures. Fortunately, GC3 is making headway on the latter issue at least.
“The traditional method for screening was the Pap smear,” said Dr. Castle, “which on the one hand has been incredibly successful, but only in a relatively small number of countries: those with a lot of resources.”
“The reason for that is manifold. One is that the Pap test has a very moderate, one-time sensitivity. And ‘moderate’ is being generous; in a lot of the lower income countries it’s very poor. There’s a lot of cost in setting up the lab, and doing it right. You have to invest in quality control to maintain performance and have feedback. There’s a variety of steps.”
Cytology and expertise in Pap smear tests is also a rather specialized skill that is expensive to teach. Such high-level training efforts can also be high-risk. Dr. Castle points out, “what we’ve typically observed over the last twenty or thirty years is that even if you were to make the effort to train up a bunch of people in cytology, what would happen is they would simply go off to the private labs and make money. And the public health programs would suffer tremendously.”
With new technological advances in screening methods and technology, new hope for a widely-implementable screening program emerges.
Tests are now advanced and user-friendly enough to allow someone with minimal training to determine whether a woman with an HPV infection is susceptible to developing cervical cancer. Those who test ‘positive’ can be asked to return for further tests, and those who test ‘negative’ can be monitored. The population of women susceptible to cervical cancer becomes much clearer and more manageable as a result.
Unfortunately, simple and effective testing methods are not enough to achieve GC3’s goals. In many lower-income countries, there is still stigma around the subject of HPV and cervical cancer, along with a sharply-felt lack of awareness.
“[Education] is a huge factor. The truth is, you’re not going to go into a country and say, ‘hey, we’re going to prevent cervical cancer here!’ because they’re going to say, ‘Well what’s cervical cancer and why should I care?’ And perhaps there are places that can’t decide, or won’t decide, whether to do cervical cancer prevention because it’s not deemed important enough.”
While the future for GC3’s ambitions is bright, its success depends on a vast number of factors and elements coming together.
“The real barrier to this cost,” Dr. Castle adds. “If we can drive the cost down by volume-purchasing, if we can get [funding groups] to not only understand that this is good for women’s health, but that it’s good for health in general, then I think we can get some countries moving forward. I’d like to see one or two countries really doing this on a national level, that fall within the World Bank definitions of middle- or lower-income countries. That would be terrific, and it would be a model for others to replicate.”
Dr. Castle’s hopes for GC3 are best summed up by a quote by Goethe that appears on the front page of the GC3 website: “Knowing is not enough; we must apply. Willing is not enough; we must do.”