Cervical cancer prevention and the Millennium Development Goals
Scott Wittet a, Vivien Tsu a
Cervical cancer kills about 270 000 women every year.1 It has been called “a case study in health equity” because most (85%) of these deaths occur in the developing world. In large part, this inequity is due to the lack of cervical cancer screening programmes in those countries – the same programmes that are taken for granted in Australia, Europe and the United States of America. And since cervical cancer affects relatively young women (mortality rates climb as women enter their forties), it results in many lost years of life – 2.7 million age-weighted years of life were lost to the disease in the year 2000.2
The biggest impacts of cervical cancer are on poverty, education, and gender equity – the first three Millennium Development Goals (MDGs). Many of those who die are breadwinners and caretakers of both children and elders. For example, in sub-Saharan Africa women head one-third of all households and in Botswana, over half of the children who have lost a parent are being cared for by grandmothers – women also at risk of cervical cancer.3,4 The fabric of the family and the community is weakened significantly when these women die. This is especially true in communities also ravaged by the loss of working adults to HIV/AIDS.
In addition to the emotional trauma, cervical cancer deaths have significant economic costs over the short- and long-term (though these are seldom considered when calculating the financial burden of disease). Family members may lose work opportunities and can incur overwhelming medical costs while caring for women with cancer.5 Reduction in family income resulting from the death of a working-age adult can force remaining family decision-makers to prioritize immediate needs (food and shelter) over investment in human capital (e.g. education). As poverty increases, more children (especially girls) may be kept out of school for lack of school fees, books, or uniforms, but also so that they can contribute to family income through work. Cervical cancer can impact education in other ways as well, such as when schools lose experienced teachers to the disease. The differential economic and social impact on women and girls makes it more difficult to achieve gender equity. Finally, it should be noted that lower levels of female education are linked to decreased maternal and infant health – the focus of two other MDGs.
Developing successful cervical cancer screening and human papillomavirus (HPV) vaccination programmes opens the door to many other interventions including, for older women, opportunities to screen for other cancers and reproductive problems, and for school-age girls and boys, deworming; treatment for schistosomiasis, onchocerciasis, filariasis and trachoma; iron and/or iodine supplementation; distribution of bed nets to prevent malaria; hand washing, anti-tobacco and anti-drug education; nutritional supplementation; body-awareness education; and guidance on life choice decision-making and sexual health.6 All of these interventions are in the immediate interest of the individual, but also will help improve maternal health and result in healthier newborns when the girls who are screened become older.
Some of the benefits of improved cervical cancer prevention are obvious – the reduction in suffering and death of mature women and the grief and economic burden felt by their families. As demonstrated above, prevention programmes can also support development in other ways, including contributing to lowering poverty, increasing primary education, empowering women, improving child health and providing the basis for global partnerships. The many barriers to realizing this potential, such as the current high cost of HPV vaccine, weakness of existing cervical cancer screening and adolescent health systems, and low levels of knowledge about HPV, now are being challenged. With sufficient political will and resources, these barriers surely can be overcome in the interest of the family and the MDGs. ■
Funding: Support for PATH’s cervical cancer prevention initiatives comes from the Bill & Melinda Gates Foundation.
Competing interests: None declared.
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- Yang BH, Bray FI, Parkin DM, Sellors JW, Zhang ZF. Cervical cancer as a priority for prevention in different world regions: an evaluation using years of life lost. Int J Cancer 2004; 109: 418-24 doi: 10.1002/ijc.11719 pmid: 14961581.
- Rural women and food security. Rome, Italy: Food and Agriculture Organization of the United Nations; 1999.
- Botswana situation analysis on orphans and vulnerable children. Francistown, Botswana: United Nations Children’s Fund, Ministry of Local Government Botswana; 2003.
- Chang S, Long SR, Kutikova L, Bowman L, Finley D, Crown WH, et al., et al. Estimating the cost of cancer: results on the basis of claims data analyses for cancer patients diagnosed with seven types of cancer during 1999 to 2000. J Clin Oncol 2004; 22: 3524-30 doi: 10.1200/JCO.2004.10.170 pmid: 15337801.
- Castilaw D, Wittet S. Preventing cervical cancer: unprecedented opportunities for improving women’s health. Outlook. 2007;23(1). Available from: www.rho.org/files/PATH_outlook23_1_web.pdf [accessed on 8 May 2008].
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