Talking about sexual and reproductive health can be difficult for many people. In the Republic of Korea, WHO recommendations are helping health authorities overcome such challenges as part of a nationwide effort to protect many girls and women from cervical cancer.
One mother, Young Shin Seo, recently took her daughter to see a gynecologist in the Gangdong district of the capital, Seoul. Her daughter was nervous, she says. But the specialist quickly put her mind at ease.
“Culturally, young girls find it difficult to actively seek advice from a gynecologist for reproductive concerns. But as a mother, I found the women’s health counselling very helpful for my daughter,” Mrs Seo says. “I had my daughter vaccinated because I heard this is the best way to prevent cervical cancer. I am glad she could get her shots while still a teenager.”
Cervical cancer: a major health challenge
Around the world, almost 280 000 women died from cervical cancer in 2015, nearly 90% in low- or middle-income countries. Unless action is taken, this number is projected to rise.
But the Republic of Korea, backed by WHO guidance, has made cervical cancer prevention, through vaccination against the human papillomavirus (HPV), counselling, screening and treatment a health priority. In doing so, it is showing action can be taken to protect girls and women from the disease. Since June 2016, the Republic of Korea has supported 12 year-old girls to visit a clinic two times, at least 6 months apart, to receive two doses of the HPV vaccine and counselling.
Immunizing girls against HPV, particularly the two types that cause at least 70% of cervical cancer cases, before they become sexually active, is the most effective way to protect them.
But vaccination is not the only measure. Screening, detecting and treating pre-cancerous lesions greatly increases chances of survival.
Cervical cancer control: a noncommunicable diseases “best buy”
The World Health Assembly has endorsed HPV vaccination and screening, through visual inspection with acetic acid, pap smears or HPV tests, as parts of WHO’s set of “best buy” cost-effective interventions for controlling cervical cancer and other noncommunicable diseases (NCDs).
In the Republic of Korea, the Ministry of Health and Welfare (MoHW) launched its National Cancer Screening Programme in 1999, which included free screening for cervical cancer to low-income populations. The programme has since expanded to provide free pap smears every two years to all women aged 30 or above, in line with WHO recommendations. In 2016, screening services were expanded to cover women aged 20 and over because more people were becoming sexually active at younger ages. To date, almost half (46.5%) of women in the targeted age group have been screened.
The government has committed to deliver comprehensive cervical cancer control services through public and private health facilities. Vaccination and screening services are provided for free through the country’s immunization and cancer control programmes. Also, the National Health Insurance Programme ensures women in need receive required treatment.
Cervical cancer on the decline
Hye Rae Kim, from the MoHW’s Division of Disease Policy, says the government’s focus on cervical cancer prevention and control is succeeding. As screening rates have risen, there has been an almost annual 4% decrease in incidence of invasive cervical cancer and related death between 1993 and 2014. This estimatation is based on mortality data collected by the National Cancer Centre, a population-based cancer registry, and Statistics Korea (KOSTAT).
“Cervical cancer screening has resulted in a more than 6% increase in detection of precancerous lesions,” says Hye Rae Kim. “This means many more women are able to seek early treatment to prevent their condition from turning into invasive cervical cancer.”
Screening, treatment improve chances of beating cervical cancer
For women diagnosed with cervical cancer, scaled up education, screening and treatment has greatly improved the chances of women overcoming the disease, with more than 80% living five years after their initial diagnosis, says Dr Hai-Rim Shin, who heads the NCD prevention and control programme for WHO’s Western Pacific Regional Office.
“An effective cervical cancer control programme, which includes vaccination, screening, treatement, counselling and palliative care are essential components of a country’s provision of universal health coverage,” explains Dr Shin.