PSI is working to pilot and scale-up effective approaches to increase women’s access to screening, treatment and referrals to decrease the risk of developing cervical cancer.
Cervical cancer kills approximately 265,000 women worldwide each year, and women in low- and middle-income countries are at highest risk for the disease. It is one of the most common female cancers throughout the developing world. A lack of effective screening coverage and access to preventive therapy is the primary driver for the high cervical cancer burden among women in the developing world. Cervical cancer screening is testing for pre-cancer and cancer among women who have no symptoms and may feel perfectly healthy. When screening detects pre-cancerous lesions, these can easily be treated and cancer avoided. Screening can also detect cancer at an early stage and treatment has a high potential for cure.
Pre-cancerous lesions can take many years to develop, so screening is recommended for every woman from aged 30 to 49 at least once in her lifetime and ideally more frequently. Three different types of screening tests are currently available:
- Conventional (Pap Smear) test and liquid-based cytology
- Visual inspection with Acetic Acid (VIA)
- HPV testing for high-risk HPV types
The WHO recommends a comprehensive approach to cervical cancer prevention and control that includes components from community education, social mobilization, vaccination, screening, treatment and palliative care. Primary prevention begins with HPV vaccination of girls aged 9-13 years before they become sexually active. Other recommended preventive interventions for boys and girls are, as appropriate:
- Education about safe sexual practices, including delayed start of sexual activity;
- Promotion and provision of condoms for those already engaged in sexual activity;
- Warnings about tobacco use, which often starts during adolescence, and which is an important risk factor for cervical and other cancers; and
- Male circumcision
Women who are sexually active should be screened for abnormal cervical cells and pre-cancerous lesions, starting from 30 years of age. Women between 30-49 years old are most at risk of developing the disease, and are therefore targeted for screening. If treatment is needed to excise abnormal cells or lesions, cryotherapy (destroying abnormal tissue on the cervix by freezing it) is recommended. If signs of cervical cancer are present, treatment options for invasive cancer include surgery, radiotherapy and chemotherapy.
With support from bi-lateral donors, foundations and private philanthropic donors, PSI has initiated cervical cancer screening and preventative therapy programs in 12 countries across our global network. We are particularly focused on screening women living with HIV, as they are at highest risk for developing the disease.
In the countries where we provide cervical screening programs, we look for ways to maximize resources by integrating cervical cancer screening into existing sexual and reproductive health programs, such as family planning or HIV testing and counseling. A number of service delivery models are used to maximize uptake of screening among eligible women. Most often, services are provided through PSI’s social franchise providers or via mobile service delivery. We also develop targeted communications campaigns to inform women, their families and communities about the importance of cervical screening and preventive therapy.
Cervical Cancer Control in Sub-Saharan Africa
With support from the Bill and Melinda Gates Foundation, PSI partners with Marie Stopes International, the International Federation of Planned Parenthood, Society for Family Health Nigeria, and Population Services Kenya to offer cervical screening and preventive treatment to women in Kenya, Nigeria, Tanzania, and Uganda.
Project objectives are two-fold:
- Scale-up quality-assured cervical cancer screening and cryotherapy as preventative treatment via social franchises and mobile outreach.
- Institutionalize cervical cancer screening and preventive therapy across PSI’s network members.
In each country, project teams work closely with Government Ministries of Health to ensure that programs meet national standards and protocols. Providers are trained according to international best practices and community health workers from each of our partner organizations conduct community mobilization.
The project aims to screen an estimated total of 1.7 million 30-49 year old women and provide cryotherapy treatment to approximately 137,000 women by integrating these services into existing reproductive health programs. We place special emphasis on reaching women who are living with HIV.
The project also provides institutional support to each of the program partners to implement cervical cancer screening and treatment across our respective reproductive health networks. This support includes:
- Training program personnel and clinical staff beyond the project countries, thus providing opportunities for learning and collaboration.
- Sharing of program tools.
- Performing operational research to understand how to integrate cervical cancer screening within existing sexual and reproductive health services.
Increasing Access to Cervical Cancer Prevention Services in Uttar Pradesh, India
Every seven minutes a woman in India dies from cervical cancer, resulting in over 75,000 deaths per year. India alone accounts for 20% of all cervical cancer cases worldwide. Due to a lack of routine screening programs, women often seek care far too late when cancer has become invasive and is untreatable.
PSI saw an opportunity for action. In 2013, with the support of a private philanthropist engaged through PSI’s Maverick Collective, PSI/India launched a pilot program in the northern state of Uttar Pradesh (UP) to screen women using a simple technique called visual inspection with acetic acid, or VIA, in accordance with WHO guidelines.
Initially, the program focused solely on increasing awareness and uptake for cervical cancer screening among clients ages 30-59 years in UP’s private sector health system. In 2014, the state health authorities invited PSI/India to serve as a technical partner to develop and disseminate a package of services through its public sector to address the growing burden of cervical cancer, as well as other common NCDs, including diabetes, hypertension, and anemia.
The Sampoorna clinics, meaning ‘complete’ or ‘comprehensive’ in Hindi, were launched in July 2015, and are now screening thousands women across 18 districts of UP. The Sampoorna public sector program is managed through the National Health Mission of Uttar Pradesh.
Since 2013, the program has:
- Established memoranda of understanding with the Indian Medical Association and three local medical colleges, and the Federation of Gynecological and Obstetric Societies of India (FOGSI), leading to greater visibility and support within the Indian medical community.
- Trained over 200 health providers across both public and private sectors to reach more women with cervical cancer screening and preventative treatment.
- Reached over 325,000 women with specific messages on cervical cancer;
- Screened over 118,000 pre-cancer lesions, and treated over 3,500 women to date. The program dispatches mobile vans to transport women for whom transportation is a barrier for further care.
Served as technical partners for Uttar Pradesh’s Sampoorna clinics who have screened 35,000 women for anemia, body mass index, hypertension, blood glucose, and cervical cancer across 18 districts Uttar Pradesh.
- Integrating Cervical Cancer Prevention Services with Voluntary Family Planning Programs
Over 311,000 women die from cervical cancer each year due to limited access to routine screening and early treatment. Many of the same countries struggling with high cervical cancer rates also have high unmet need for family planning (FP). As the global health community has prioritized both the reduction of unmet need for FP and, more recently, the global elimination of cervical cancer, there is an opportunity to review the evidence base and share practical considerations for integration of these services, with a view towards expanded access to products and services that improve women’s sexual and reproductive health.
- Non-Communicable Disease Life Course Pocket Cards
At the 61st session of the UN"s Commission on the Status of Women, PSI and its partners on the Women and NCDs Task Force promoted a set of pocket cards illustrating a woman's risk for non-communicable diseases over the course of her lifetime.
- Cervical Cancer Screening and Prevention, and Barriers to Uptake: A Review of the Evidence
This review explores cervical cancer screening methods and the barriers and facilitating factors to uptake of screening and treatment services in developing countries.
- Integrating Cervical Cancer Screening Within Family Planning Service Provision in Peri-Urban Zambian Setting
In Zambia, cervical cancer (CACX) screening was introduced in 2006. Since then over 189, 000 women have been screened for CACX. While incidence and mortality rates of cervical cancer have fallen significantly in developed countries, 83% of all new cases that occur annually and 85% of all deaths from the disease occur in developing countries. Family planning (FP) services in Zambia have traditionally been offered routinely in maternal and child health (MCH) settings. The Society for Family Health (SFH) provides FP services using a dedicated provider model in high volume public sector health facilities since 2008. The model emphasises long-acting reversible contraception (LARC), while assuring method choice.
- PSI Health Impact Estimation Model for Cervical Cancer Prevention: Screening and Referral/Treatment
PSI uses the disability-adjusted life year averted (DALY averted) to measure the impact of interventions in health areas. A statistical model has been developed for each of PSI’s product, service, and behavior change communication interventions. The model presented here is the Cervical Cancer Prevention health impact model.