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Eliminating cervical cancer

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May is Cervical Cancer Awareness Month. Each year in the Philippines, 7,897 women are diagnosed with cervical cancer, and 4,052 die from the disease. Cervical cancer is the second most common cancer among women in the Philippines, including those between the ages of 15 and 44, according to the Department of Health (DoH).

The main cause of cervical cancer is persistent infection with high-risk types of human papillomavirus (HPV) that are transmitted through sexual contact. Common signs and symptoms of cervical cancer include blood spots or light bleeding between or following periods; menstrual bleeding that is longer and heavier than usual; bleeding after intercourse, douching, or a pelvic examination; increased vaginal discharge; pain during sexual intercourse; bleeding after menopause; and unexplained, persistent pelvic and/or back pain.

The Philippines could eliminate cervical cancer by 2064 with concerted action across three “elimination pillars” identified by the World Health Organization (WHO) in its “Global strategy to accelerate the elimination of cervical cancer as a public health problem.” These pillars are HPV vaccination, cervical cancer screening, and cervical cancer treatment.

The Strategy proposes an elimination threshold of four cases per 100,000 women, achieved by implementing the triple intervention targets by 2030: 90% of girls fully vaccinated with the HPV vaccine by age 15; 70% of women screened with a high-performance test (such as the HPV DNA test) by 35, and again by 45 years; and 90% of women identified with cervical precancer or invasive cancer receive adequate treatment and care.

The HPV vaccine has been proven to be safe and effective (close to 100% efficacy) at protecting against HPV and reducing HPV infections, which reduces the risk of cervical cancer and other cancers (vaginal, vulval, and penile cancer, among others) caused by HPV, according to the US Centers for Disease Control and Prevention (CDC). However, while HPV vaccination has been available in the Philippines since 2016, widescale coverage has yet to be achieved.

The Strategy recommends facilitating the scaling up of HPV vaccination coverage by considering multisectoral delivery platforms, including a school-based strategy targeting adolescent females aged nine to 14 years, or innovative community-based strategies. It also suggests securing sufficient and affordable HPV vaccines, through a concerted effort to negotiate for reasonable prices and with international partnerships and support, including from GAVI, a public-private global health partnership which aims to increase access to immunization in developing countries.

The Strategy estimates that HPV vaccination could prevent nearly 94,050 cervical cancer deaths by 2070, and 688,966 cervical cancer deaths by 2120.

According to the Strategy, cervical cancer screening programs could be integrated with existing services such as primary care services, for instance by offering HPV testing at reproductive health clinics, ante-natal care consultations, family planning consultations or women’s health clinics. Integrating cervical cancer screening with facilities that offer services for HIV control should be considered to ensure women at high risk of cervical cancer have access to cervical cancer screening. This would minimize unnecessary referrals and reduce transport costs and waiting time for women.

The Strategy proposes offering self-collection for HPV testing, or point-of-care HPV testing in rural areas, so that women who need pre-cancer treatment can be treated in the same visit. It calls for the utilization of clinically validated high-sensitivity tests in screening scale-up, and strengthening of laboratory services and quality assurance programs to ensure the program is effective. The Strategy also recommends implementing surveillance and monitoring systems to ensure women are not lost to follow-up and to monitor program success nationally.

The effects of cervical cancer screening and pre-cancer treatment in the country will be seen mainly in the mid-term, after 2030. Cervical cancer screening would prevent an additional 960 cervical cancer deaths by 2030, 112,880 deaths by 2070, and 173,874 cervical cancer deaths by 2120.

The Strategy underscores the importance of developing and implementing national cervical cancer management guidelines in providing women with high-quality cancer treatment and care. Establishing strong referral networks between all aspects of the cancer care spectrum is needed to ensure the timely management of patients and reduce loss-to-follow-up. Diagnosis, treatment, and monitoring of invasive cervical cancer will require high-quality pathology services and oncology services.

The Strategy calls for safe, effective, and timely surgery accompanied by supportive services such as anesthetic services and intensive care units for the treatment of early-stage cancers.

Cervical cancer treatment scale-up will have immediate impacts on deaths averted. The Strategy estimates that the scale-up of cancer treatment would prevent an additional 7,262 cervical cancer deaths in the country by 2030, 75,922 deaths by 2070, and 110,421 cervical cancer deaths by 2120. If the three pillars of elimination are established, the Philippines could avert over 970,000 deaths due to cervical cancer over the next century.

Each time a woman succumbs to cervical cancer, we lose a mother, a wife, a daughter, a grandmother, a colleague, and a friend. Each time a young woman gets cervical cancer, her chances of becoming a mother, a wife, having children, being a grandmother, or being a leader in her field of work or advocacy is lost to the disease. These are the foremost reasons why we must take cancer seriously.

 

Teodoro B. Padilla is the executive director of Pharmaceutical and Healthcare Association of the Philippines (PHAP). PHAP represents the biopharmaceutical medicines and vaccines industry in the country. Its members are in the forefront of research and development efforts for COVID-19 and other diseases that  affect Filipinos.