Govt should adopt new recommendations for Cervical Cancer screening and treatment

Too many women worldwide especially the poorest women continue to die from cervical cancer; a disease that is both preventable and treatable. In 2020, more than half a million women contracted cervical cancer, and about 342,000 women died as a result, most in the poorest countries. Thus, quick and accurate screening programs are critical so that every woman with cervical disease gets the treatment she needs, and avoidable deaths are prevented.

In 2020, the World Health Organization (WHO) launched a new guideline to help countries make faster progress, more equitably, on the screening and treatment of this devastating disease. This called for 70% of women globally to be screened regularly for cervical disease with a high-performance test, and for 90% of those needing it to receive appropriate treatment. Alongside the vaccination of girls against the human papillomavirus (HPV), implementing this global strategy could prevent more than  62 million deaths from cervical cancer in the next 100 years.

The new guideline recommends an HPV-DNA-based test as the preferred method, rather than the visual inspection with acetic acid (VIA) or cytology (PAP smear), which are currently the most commonly used methods globally to detect pre-cancer lesions. The HPV-DNA testing detects high-risk strains of HPV which cause almost all cervical cancers. Unlike tests that rely on visual inspection, HPV-DNA testing is an objective diagnostic, leaving no space for interpretation of results. Although the process for a healthcare worker obtaining a cervical sample is similar with both cytology (aka PAPA smear) and HPV-DNA testing, HPV-DNA testing is simpler, prevents more pre-cancers and cancer, and saves more lives than VIA or cytology. Additionally, HPV-DNA testing it is more cost-effective.

More access to commodities and self-sampling is another route to consider for reaching the global strategy target of 70% testing by 2030. The WHO suggests that self-collected samples can be used when providing HPV-DNA testing. Research studies show that women often feel more comfortable taking their own samples, like in the comfort of their own homes, rather than going to see a healthcare worker for cervical cancer screening. However, women need to receive appropriate support to feel confident in managing the process.

The WHO therefore suggests using either of the following strategies for cervical cancer prevention for a general population of women:

• HPV-DNA detection in a screen-and-treat approach starting at the age of 30 years with regular screening every 5 to 10 years and
• HPV-DNA detection in a screen, triage and treat approach starting at the age of 30 years with regular screening every 5 to 10 years

The WHO further suggests using the following strategy for cervical cancer prevention among women living with HIV:

• HPV-DNA detection in a screen, triage and treat approach starting at the age of 25years with regular screening every 3 to 5 years

In Uganda, the Ministry of Health has not rolled out this HPV-DNA testing method to various health facilities as a strategy for cervical cancer screening, triage and treatment. However, a few private health facilities in Uganda have adapted this effective method. 

I, therefore, recommend MoH Uganda to adopt the HPV-DNA testing method since it is simpler, prevents more pre-cancers and cancer, saves more lives than other methods and is more cost-effective.

The author is; Lilian Nuwabaine Luyima; BSc Nurse & MSN-Midwife & Women’s Health Specialist working with Aga Khan University as the CPD Coordinator & is the Heroes in Health Award Winner-Midwife of the year 2021