“These people saved my life. They have not only saved the woman but they have saved the mother of a small child,” says Pratibha, a woman who lives in rural India. Although Pratibha felt perfectly well, she agreed to be screened for cervical cancer when health workers visited her village. Unlike many less fortunate women, Pratibha’s cancer was detected early enough to save her life. She remembers, “Previously, I thought that I am a very unlucky woman because there was a positive report. But now I feel how lucky I am! My disease was detected in the earlier stage. And I got treatment for free.”

Pratibha’s screening and subsequent treatment was part of the research project funded through the Alliance for Cervical Cancer Prevention, a group of international health organizations led by PATH. The organizations are EngenderHealth, International Agency for Research on Cancer, JHPIEGO, Pan American Health Organization, and PATH. The Alliance organizations aim to prevent cervical cancer in low-resource settings by:

• Conducting research on new methods of screening and treatment and exploring ways to improve women’s access to these services.
• Developing strategies to involve the community so that people understand the importance of screening and women feel supported and empowered in their decision to be screened.
• Raising awareness about the importance of cervical cancer prevention among policymakers, donors, health care providers, educators, and the media.

Preventable deaths

Close to a half million women are diagnosed with cervical cancer each year, and nearly a quarter million women die from the disease. Most live in developing countries, where cervical cancer is often the leading cause of cancer deaths among women.

Women don’t have to die of cervical cancer. The disease develops slowly after initial infection with the human papillomavirus and, unlike most other cancers, it is preventable when precursor lesions are detected and treated.

However, millions of women around the world are never screened for cervical cancer—whether it is because of the day-long journey to the nearest clinic, local myths and fears about cervical screening, or poor health services. Screening is essential because women often do not experience symptoms until the disease has advanced.

Tailoring screening to low-resource settings

The Alliance organizations assess obstacles to screening and treatment, and they look for approaches that work in low-resource settings. Successful approaches must be safe, effective, and culturally acceptable to women—and they must work without the health care infrastructure that screening programs in wealthier countries rely on.

In addition to leading the Alliance, between 1999 and 2004 PATH conducted projects in Peru and Kenya. In Peru’s San Martín region, we collaborated with the Pan American Health Organization and the Peruvian Ministry of Health to assess a screening approach called visual inspection with acetic acid (VIA). Because VIA requires only a good light source and acetic acid (white table vinegar), screening and treatment can occur in a single visit. The project also sought to improve service quality by involving women from the villages. They advised health care providers on interacting with clients, and some led awareness-raising activities in their communities.

In Kenya, PATH collaborated with local partners and the Ministry of Health to develop and evaluate a cervical cancer prevention program suitable for rural, low-resource settings in Africa.

Raising awareness

Collectively, the Alliance’s research findings suggest that it is possible to implement successful cervical cancer prevention programs in low-resource settings. Alternative screening methods, such as testing for DNA from the human papillomavirus; visual inspection; and one-visit, screen-and-treat approaches show promise for reducing the disproportionate burden of cervical cancer that women in developing countries carry. The Alliance is now communicating these findings—through fact sheets, manuals, issue papers, and other materials, all available at www.alliance-cxca.org—to policymakers, program planners, health care providers, community leaders, and researchers around the world.

The next frontier

Newly available vaccines against human papillomavirus, which causes almost all cases of cervical cancer, are also a promising approach for low-resource settings. Building on the partnerships we have developed through the Alliance, and with an eye toward the future, PATH has launched a project aimed at accelerating access to these vaccines in the developing world.

Every woman deserves the opportunity to avoid cervical cancer, no matter where she lives.

Photo: Anne Boyd.