Why are Women Dying from a Preventable Disease?

by Dr. Carmen Barroso
–USA–

Diseases such as diabetes and cancer cause tens of millions of deaths each year, many of which are premature. Once the burden of rich countries, these non-communicable diseases are increasingly affecting individuals in low- and middle-income countries where they impose heavy burdens on already fragile health systems. Among the most deadly—and preventable—of these diseases is cervical cancer.

Women in developing countries account for 80 percent of all new cases of cervical cancer worldwide and new research shows this rate is continuing to rise. Effective screening programs are largely unavailable in poor countries. As a result, most women with cervical cancer reach health services only after the disease has reached an untreatable advanced stage, condemning them to a horrible death.

Following the earthquake in Haiti, International Planned Parenthood Federation/Western Hemisphere Region’s colleague PROFAMIL was one of the few local organizations providing essential health services. PROFAMIL faced the daunting task of maintaining operations while rebuilding its reproductive health clinics and replacing lost or damaged equipment. Their determination to meet the overwhelming demand for services, including visual screenings for cervical cancer, resulted in a staggering $225,000 projected budget deficit for the organization. Despite these setbacks, PROFAMIL continued to provide vital care and information to more than 26,000 people — and out of the tragedy an innovation emerged.

Visual Inspection with acetic acid—or vinegar—is a new screening technology developed specifically for low-resource settings. It does not require sophisticated lab equipment, assessment is immediate, and in many cases the client can be treated immediately. It is highly effective in detecting precancerous lesions, and because it is just $3 dollars per screening, this method is more cost-effective than Pap smears, which cost $40 dollars.

PROFAMIL has now trained all of its clinical staff and community health educators on how to use the visual screening method. It allows staff to detect precancerous lesions with the naked eye and provide simple treatment. The organization is currently working with the Ministry of Health to train new medical graduates in this technique, which has been proven to identify up to 79 percent of women at high risk of developing cervical cancer.

In Medicine on the Move, Leona Adolfo, a nurse at PROFAMILIA in the Dominican Republic, says, “If this project didn’t exist, there would be more women with cancer.” A community member agrees, “If it weren’t for PROFAMILIA, I’d be dead. I didn’t have any money to go to the doctor or anything. But—thank god for PROFAMILIA—I am alive.”

Human papillomavirus, or HPV, is an extremely common infection that causes cervical cancer. In the United States, over six million women and men get an HPV infection every year, a statistic that has led some doctors to claim that it is nearly as widespread as the cold virus. Yet unlike the common cold, HPV is transmitted sexually, making it a political hot potato.

HPV vaccinations could be part of the assistance the United States provides poor countries to improve women’s health worldwide, but this year’s budget reduces foreign assistance for reproductive health and family planning, and Republicans intend to further slash these programs in 2012.

The loss of life from cervical cancer is even more forebodinging because the disease is entirely preventable. Vaccinating adolescent girls against HPV could drastically reduce the incidence of cervical cancer in places like Bolivia, which has alarmingly high rates. International Planned Parenthood Foundation/Western Hemisphere Region (IPPF/WHR) member CIES provides nearly 400,000 health services annually – including Pap smears and family planning – through fourteen clinics and mobile health clinics that operate in hard-to-reach communities. In partnership with the government and a Gardasil access program, CIES offers the vaccine in schools, health centers, and mobile clinics to ensure widespread access. To date, more than 78,000 girls have received vaccinations.

Vaccines, however, are only one part of the broad strategy that is needed to combat this disease. Simple and smart investments in screening and treatment in developing countries are critical, and recent breakthroughs in cervical cancer prevention provide an historical opportunity to dramatically reduce the disease in the developing world.

A comprehensive approach that includes screening, pre-cancer treatment, and HPV vaccination could save the lives of the nearly 300,000 women who will die from cervical cancer this year. Combating the disease requires resources, cooperation, and a commitment to securing universal access to reproductive health. It also requires sexuality education so young people learn how to protect themselves, and investments in emerging technologies such as a rapid HPV test.

As Sarah Nyombi, a member of Uganda’s Parliament once wrote, “Given the tools that are available, even one cervical cancer death is too many.” Hopefully, world leaders will reach the same conclusion and make cervical cancer a higher priority on the global health agenda.

• Lucella Campbell, Senior Program Advisor at PROFAMIL, speaks
about the work being done in Haiti. •

About the Author:
Dr. Carmen Barroso is the Regional Director of International Planned Parenthood Federation/Western Hemisphere Region.