This post originally appeared on www.bushcenter.org. Today marks World Health Day, set aside annually by the World Health Organization (WHO) to draw attention to the importance of global health, and to solidify the WHO’s mission to foster “the highest attainable standard of health.” For us at Pink Ribbon Red Ribbon, the public-private partnership housed at the George W. Bush Institute dedicated to reducing incidences and mortality of cervical and breast cancer in sub-Saharan Africa, the highest standard of health for women will be attainable only when screening for cancer is part of the package of services available to every woman. In other words, when those who need treatment have access to the full continuum of cancer control and care. In the United States and other developed countries, when a woman is told she has cancer, the next steps for treatment are almost automatic. She has an answer to the question, “What do I do next?” In some parts of the world, and especially in sub-Saharan Africa, most women have almost no access to “the next step.” To ensure the best outcomes for women with cancer, we believe that a full continuum of cancer control and care must be in place, so every woman knows what can be next for her. The Continuum of Cancer Control and Care A full continuum of care in terms of cervical cancer means that women should have access to these key services:
- Primary Prevention: Vaccinating adolescent girls against the human papillomavirus (HPV), the virus that causes most cervical cancer, provides a 70-percent guarantee that any girl who receives all of the recommended doses of the vaccine will not develop cervical cancer later in life. In Ethiopia, for example, that means that if 70 percent of nine-year old girls were vaccinated with three doses of HPV vaccine in one year, 14,000 future deaths could be prevented.
- Screening and Treatment: Early detection, followed by immediate treatment of detected pre-cancerous lesions, can prevent the majority of cervical cancers. In developing countries, healthcare workers use simple, low-cost technology such as visual inspection with acetic acid (VIA) to determine if pre-cancerous lesions are present. If they are small lesions, a health worker can remove them with cryotherapy, and the woman can go home within a few hours. This prevents her from having to come back to a health center, a step that proves difficult in many instances, because of work and family obligations. The approach can be taught to mid-level health workers like nurses and midwives, and does not require the advanced skills of a physician. As a result of this approach, more than 153,000 women have received screening in Zambia, Botswana and Tanzania through programs supported by Pink Ribbon Red Ribbon.
- Referral: Women diagnosed with large precancerous lesions and those with early invasive cervical cancer can usually benefit from referral to loop electrosurgical excision procedure (LEEP), pathology, surgery, radiotherapy and chemotherapy, or some combination of these treatments. In countries where healthcare workers lack training, skills or equipment, or where radiotherapy machines are down for extended maintenance, this step in the continuum can prove challenging.
- Palliative Care: Palliative care is an essential element of helping a woman with cervical cancer when her disease has advanced to a point where needs improved quality of life relatively free-of-pain or is in the final phases of life. Palliative care is best provided by using a multidisciplinary team approach that involves the patient, her family and close support persons, community health workers and special palliative-care workers in the community, as well as health care providers at all levels of facilities.