Commentary - Leslie Mancuso: Cervical cancer prevention for all women — everywhere

Nevertheless, you may be surprised to learn that cervical cancer is the second most-common form of cancer in women worldwide, with 500,000 new cases and 250,000 deaths reported each year. More than 80 percent of new cervical cancer cases occur in developing countries, where access to modern medical technology is often limited; in fact, more than 95 percent of the women in these countries have never had a Pap test.

Cervical cancer is particularly cruel because it strikes women in the prime of life, while they are caring for their children and families. As is often the case in poor countries, the loss of the mother results in dire health and economic consequences for her immediate family and her community. The cycle of poverty and despair perpetuates from each case of cervical cancer diagnosed in countries like Malawi and Indonesia.

But there is reason to be hopeful, even for women in the most remote regions of the globe. JHPIEGO, an international health organization affiliated with The Johns Hopkins University, has pioneered a cost-effective, innovative approach to cervical cancer prevention that requires neither advanced medical screening — nor even electricity. During what is known as the Single Visit Approach (SVA), a doctor, nurse or midwife trained in the technique applies a dilute acid solution (vinegar) to the woman’s cervix. Precancerous lesions revealed by the solution can often be treated by cryotherapy (freezing) at the clinic. Most women screened through SVA go on to lead lives free from cervical cancer. This low-cost, low-tech approach is safe, acceptable and feasible for women without access to the Pap test.

Ministries of Health in several developing countries have introduced SVA into routine reproductive health screening programs. In Thailand, SVA is now part of a strategy adopted and funded by the Thai government to prevent cervical cancer. In Ghana, a pilot project conducted by JHPIEGO from 2001-04 has led to the continuation of services at all four pilot sites, with plans for broadening the intervention nationally. Ministries of Health in South Africa, the Philippines, Malawi and Indonesia are also among those using or planning to incorporate SVA as part of their cervical cancer prevention programs.

The HPV vaccine is part of the strategy for protecting women from cervical cancer in developing countries as well. For example, mothers being screened through SVA can be encouraged to bring their daughters to the local clinic for vaccination. In years to come, once the vaccine becomes more broadly available, we may be able to envision a future without cervical cancer. As a nurse and the head of a global health organization devoted to the care of women and their families, this is some of the best possible news.

For the moment, though, women in developing countries still need low-tech and low-cost care to prevent this virulent form of cancer. When scheduling your annual Pap or making an appointment to vaccinate your daughter against HPV, I encourage you to consider how fortunate we are to have ready access to this technology — and join me in supporting programs for women worldwide who continue to experience unacceptable rates of suffering and death from this most preventable form of cancer.

Leslie Mancuso is president & CEO of JHPIEGO, an international health organization affiliated with The Johns Hopkins University in Baltimore, Maryland. JHPIEGO’s focus is on training and support for health care providers — including doctors, nurses, midwives and health educators — working in limited-resource settings throughout Africa, Asia, the Middle East, Latin America and the Caribbean.