Why Can’t We Commit to Early Detection?
06/04/2010
Jhpiego President Leslie Mancuso on why policy makers need to commit to expand cervical cancer screening
In Guyana, Jhpiego has trained health providers in a low-cost, effective cervical cancer screening method.
Photo courtesy of Jhpiego.
More than 60 years ago, a doctor from Cornell University discovered that precancerous cells from the cervix could be identified before they turned lethal. The finding revolutionized the screening and treatment of cervical cancer. Dr. George Papanicolaou’s "Pap" test became routine for women and within two decades, deaths from cervical cancer in the United States decreased dramatically – a reduction of 74 percent.
A far different scenario confronts women in the developing world today. As we gather this week for 2010 Women Deliver, it’s important to remember that for many thousands of women around the world, a visit to a doctor is rare, the local health clinic does not have reliable electricity or a laboratory or supplies to process a Pap test and routine screening for this preventable cancer is unavailable. As a result, cervical cancer remains the leading cause of cancer deaths among women in developing countries.
Tragically, when many women discover they have cervical cancer it’s often too late – and can’t be treated successfully. That’s unacceptable, especially when a simple, easy solution exists to screen women from Antigua to Zambia.
A “single visit approach” is an effective, efficient screening method designed to serve women in poor urban and rural areas. Health care providers trained in this approach use house hold vinegar to swab the cervix and then conduct a visual examination with a strong light. As a result of the light and acetic acid (the main ingredient of vinegar), precancerous lesions appear whitish. If abnormal cells are detected, a patient is offered treatment options on the spot, usually a freezing technique known as cryotherapy.
Our organization has trained health care providers in the Philippines, Guyana, Cote d’Ivoire and Thailand in the single visit approach, which has been endorsed by the World Health Organization (WHO) and FIGO, the International Federation of Gynecology and Obstetrics. The result has been that thousands of women have been screened for cervical cancer.
But thousands more could and should be screened. With a sound, affordable solution to a tragic fatal condition at our fingertips, there’s no reason women should be denied this life-saving service.
In Guyana, for example, the single visit approach has become the model for a national screening effort. A clinic was established at Georgetown Public Hospital and 13 health care providers across the country were trained in this method. With Jhpiego's help, 6,890 women in Guyana were screened for cervical cancer and more than 1,000 received immediate life-saving treatment. That quick response could be replicated throughout the developing world as health officials and policy makers commit themselves to expand the use of this strategy.
The prevalence of HIV/AIDs in women in developing countries makes the need for national screening programs more urgent. The human papillomavirus (HPV), the leading cause of cervical cancer, is more aggressive in HIV-infected women because their immune system is weakened and they can’t fight it. Some of our health care partners are seeing women with AIDS die of cervical cancer because of a lack of screening.
About 288,000 women a year die from cervical cancer, according to WHO. Most live in the developing world. With cervical cancer, early screening is the ounce of prevention that can cure. No woman should be denied that opportunity.
This article is part of a series that support the issues highlighted in Women Deliver.
Dr. Leslie Mancuso is the president and CEO of Jhpiego, a Baltimore-based international health non-profit that pioneered the single visit approach to screen for cervical cancer in underserved areas of the developing world.
Thank you Dr. Mancuso for this great overview of the Single Visit Approach.
Jhpiego’s pioneering work has paved the way for organizations like Grounds for Health. Grounds for Health trains local health providers in the Single Visit Approach in coffee-growing communities in Nicaragua, Mexico, and Tanzania. With SVA we’ve reached thousands of women, and have the potential to help tens of thousands more.
Cervical cancer is a problem that we can solve right now.
And with further adoption of the Single Visit Approach we can work together to get there.
Thanks again.
Best,
Justin
Communications Specialist
Grounds for Health
— Justin Mool on 2010-06-07
I send a special greeting to my dear friend and teacher Leslie Mancuso, who welcomes the initiative to promote other countries, other women in the world the opportunity to save their lives by detecting the time of Uterus Ca and providing early treatment for women with an abnormality resulting cell. I strongly agree with my dear Leslie, we need to strengthen this work by joining efforts to fight against Ca Uterus and save more lives.
I can ensure that she remembers me, (Teresa Narvaez) who works in the Dominican Republic since 1996, with Project HOPE and the Dominican Association of the Order of Malta. We currently have two maternal and child health clinics and soon we will have a third in a very populous and economically disadvantaged area.
The clinics offer PAP. Test, and we would explore the opportunity to expand the Jhpiego’s Program, Effective cervical cancer screening method, for more women in our clinics and communities, in DR.
Thanks
Lic. Teresa Narvaez Villarreal
Director, Project HOPE Dominican Republic
— Teresa Narvaez on 2010-06-09
Thank you, Dr Mancuso, for a thoughtful summation of the current problems and potential improvements for cervical cancer screening in vulnerable and under-served populations.
I would add that it is important that these services be included in an integrated primary health system for the most efficient use of resources and effective improvement in overall health levels. Family planning, maternal-child health, HIV/AIDs screening/rx, vaccines and gyn care all naturally complement each other.
There are too many well-intended silos of care and it is critical that each component be promoted in a way that furthers primary care health systems.
Thanks again for your words and all the work that Jhpiego does around the world
Lewis Holmes MD
— Lewis Holmes on 2010-06-10
Dear Dr.Mancuso,
As I read through in the library now, I am trying to imagine where did the rain start beating us here in Kenya. Health Policies are rarely implemented to book.
I want to deeply appreciate this insights that have brought greater understanding on cervical cancer,that truly as a primary service provider we can safeguard women’s lives by screening them from any point of entry as they seek health services.
I will be doing a major screening and a walk in one of the biggest slums in Kenya (Kibera).16TH OCT 2010.I thank JHPIEGO for their continued support in Kenya.
It has been quite reassuring to have read from you to know that cacx,is treatable.
Kind Regards
— LUCIA BUYANZA,BSCN, AGA KHAN UNIVERSITY,KENYA on 2010-07-14
Thank you for the great work. Cervical cancer is a silent killer and the world must embrace screening as a way to deal with the problem.
— Anangwe Munala Samson on 2011-04-02
Dear Dr Mancuso,
You have simplified the screening and made it practically more applicable to masses.Congratulations
rooplekha Chauhan
— roop lekha chauhan on 2011-06-02
The right time to plant a tree was 10 yrs back,if we did not do this, then the right time to plant is now,It really pains to see our women down in the villages suffering for A disease which would have been prevented in the first place by simple basic screening,Thanks again and again for this kind of move,May our Mothers,sisters,aunties live longer now!!.
— Richard Lando on 2011-06-29
I believe it is never late for women in Kenya to undergo cervical cancer screening.What is needed is creating public awareness campaigns by educating women to embrace screening and save more lives.
— Jacqueline on 2011-07-22
Dear friend
am happy for your concern and efforts to reduce deaths due to cancer.
am called violet and i coordinate a family planning integration study. i am also concerned about the high number of women presenting with signs suggestive of cancer. i meet so many clients who have the cardinal signs but cannot access the screening and testing. recently i talked to the AMUAproject -marie stopes who assisted in screening and we managed to get 20 women with cervical cancer but they could not access the treatment because of the distance to the district hospital and there economic status. its so painful to see them go own and not able to get early treatment
— VIOLET NASENYA on 2011-08-17
Hi thansk for the info. its my first time to see it.
My question is, is there a questionnaire that health workers can use to asses women on cancer screening.
— Meshack Mwangala on 2011-09-06