The World Health Organization (WHO) Essential Practice Guidelines for the Integrated Management of Cervical Cancer (Second Edition), which are designed to help countries around the world better prevent and control cervical cancer. Cervical cancer is one of the world’s deadliest yet most preventable cancers in women. Globally, more than 270,000 people die from cervical cancer each year, with up to 85 percent of those deaths occurring in developing countries.
The World Cancer Leadership Summit, held in Melbourne, Australia, on December 3, 2014, launched the Essential Practice Guidelines for the Comprehensive Management of Cervical Cancer (Second Edition). The guidelines update the Essential Practice Guidelines for Comprehensive Cervical Cancer Control (2006 Edition), highlighting recent advances in technologies and strategies to enhance women’s access to health services for the prevention and control of cervical cancer, and are expected to address the gap between demand and service availability for cervical cancer prevention and control.
The updated WHO cervical cancer guidelines can be life-saving for girls and women around the world,” said Dr. Nathalie Broutet, a WHO expert in cervical cancer prevention and control. There is no silver bullet, but preventing and treating cervical cancer through a combination of more effective and affordable tools will help lift the pressure on overburdened health budgets, especially in low-income countries, and contribute significantly to the elimination of cervical cancer.”
Foreword
Cervical cancer is one of the most serious threats to women’s lives. It is estimated that more than one million women worldwide are currently living with cervical cancer. Many of these patients do not have access to health services for prevention, curative treatment or palliative care. In 2012, 528,000 new cases of cervical cancer were diagnosed and 266,000 patients died from the disease, nearly 90 percent of whom were in low- and middle-income countries. Without urgent attention, cervical cancer deaths are expected to rise by nearly 25 percent over the next 10 years.
Cervical cancer occurs worldwide, but its incidence is highest in the south-central United States, eastern Africa, South and Southeast Asia, and the Western Pacific. Over the past 30 years, cervical cancer rates have declined in most developed countries, in large part as a result of screening and treatment programs. In contrast, the incidence of cervical cancer in most developing countries has trended upward or remained the same.
This is often due to limited access to health services, lack of awareness and lack of screening and treatment planning. Rural women and poor women living in developed countries are also at greater risk of cervical invasive cancer.
Most women who die from cervical cancer, especially in developing countries, are still relatively young. They may need to raise children, take care of their families, and contribute to social and economic life in both rural and urban areas. A woman’s death is both a personal tragedy and a source of grief and unnecessary loss to her family and community. There is compelling evidence that cervical cancer is one of the most preventable and treatable forms of cancer if the disease is detected and and managed effectively at an early stage, so the deaths of these patients are unnecessary.
Less developed countries are clearly more likely to lack effective health systems and adequate financial resources than developed countries. Also women’s lack of equal access to health care in society is an important reason. We can address the need for adequate resources and improved health care for women in developing countries. The new guidelines emphasize better addressing gender discrimination and incorporating a range of other social factors (e.g., wealth, education, religion, ethnicity) into the design of health policies and programs.
In 2007, as a policy matter, the World Health Assembly adopted a resolution that the World Health Organization (WHO) and its member states would work on the process of gender mainstreaming. Gender mainstreaming is the process of making the concerns and experiences of both women and men an integral part of the design, implementation, monitoring and judging of all policy programs in the political, economic and social spheres, so that both women and men benefit equally and inequalities no longer occur. The ultimate goal of mainstreaming is to achieve gender equality.
WHO advocates for more attention and resources to be devoted to women’s health, prioritizing maternal health programs, while also actively participating in strengthening health systems and developing, testing and implementing appropriate technologies to make cervical cancer care feasible and affordable in low- and middle-income countries. The development of new technologies will offer the possibility of preventing and controlling cervical cancer in a more comprehensive way, building a healthier future for women worldwide.
The increased availability of optional screening technologies, such as visual inspection with acetic acid (VIA), HPV testing, and the human papillomavirus (HPV) vaccine, can help prevent many cervical cancers. In addition, the primary target population for HPV vaccination is early adolescent women ages 9-13 who are not sexually active and have the opportunity to prevent and control cervical cancer through this method and then be screened for cervical cancer at ages 30-49.
The guidelines identify the main opportunities and ages in a woman’s life when she can take action for cervical cancer control and prevention, addressing in particular
Primary prevention: vaccination of girls aged 9-13 years against HPV in order to immunize them before they begin sexual activity.
Secondary prevention: technical services such as VIA (visual inspection with acetic acid) or HPV test screening for women over 30 years of age, followed by treatment of detected precancerous lesions that may develop into uterine cancer.
Tertiary prevention: Cancer treatment and management for women of any age, including surgery, chemotherapy and radiation therapy.
Providing palliative care is essential in cases where curative treatment is no longer possible.
A range of different health services and programs are necessary to implement each of these recommended elements, and the guidelines emphasize the need for collaboration between sectors, between health programs, and between professionals at all levels of health services to enable successful prevention of cervical cancer. The guide also describes how to integrate the prevention and control of cervical cancer into existing health care delivery systems, including family planning, postpartum care, and HIV/AIDS services. Vaccinating adolescents can open up avenues to provide them with more health information, sex education, and advice on healthy lifestyles.
Cervical cancer prevention and control programming supports the UN Secretary-General’s 2010 Global Strategy for Women’s and Children’s Health. Cervical cancer was recognized in the 2011 Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases.
The 2013 World Health Assembly included cervical cancer prevention as a priority intervention in the Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2020, on which Member States have reached consensus and committed to include cervical cancer and other NCD interventions in national health plans. The guidelines provide a broad view of integrated programs for cervical cancer prevention and control pathways.