Cervical cancer is a major cause of premature death and disability among women. Worldwide, approximately 311,000 women die of the disease, and 570,000 new cases are identified annually according to the World Health Organisation.
Women in low- and middle-income countries account for nearly 90 per cent of all cases globally, in part due to limited access to cervical cancer prevention services.
While cervical cancer is easily detectable and curable in its early stages, only five per cent of women in developing countries undergo screening compared to more than 40 per cent in developed countries.
As a result, Africa's very low screening rates means that the majority of women present advanced stages of the disease. In Kenya, only 16 per cent of women aged 25-49 have been screened, according to the National Cancer Screening Guidelines.
This is a sharp contrast from the recommended 70 per cent to put Kenya on its path to cervical cancer elimination.
The risk of cervical cancer rises with sexual activity, which potentially exposes one to the human papillomavirus, a sexually transmitted infection so common that nearly all men and women get it at some point, as per findings by the Centre for Disease Control and Prevention.
Furthermore, cervical cancer is the most common cancer among women living with HIV, who are six times more likely at risk than women not living with HIV, according to WHO. As a consequence, many countries struggling with high cervical cancer rates often have a high unmet need for family planning.
The global health community has prioritised both the reduction of unmet need for family planning and, more recently, the global elimination of cervical cancer. There is an opportunity to review the evidence and share practical considerations for the integration of these services.
This is with a view towards expanded access to products and services that improve women’s sexual and reproductive health holistically.
The integration of cervical health into family planning service delivery is therefore critical to closing the gap in missed opportunities and triggering demand for sexual and reproductive health services among women of reproductive age and those who need to be reached for cervical cancer screening and treatment.
As countries continue to evaluate opportunities for launching and scaling integrated services, sustained political will and multi-sectoral stakeholder collaboration are critical.
Coordination by the National Cancer Institute of Kenya at the national level, for example, can unlock the full potential of facilities such as the Tunza franchise clinics that are expanding access to screening and treatment alongside family planning, and movements like Kizazi Chetu that work to broaden public awareness and conversation on cervical health.
It is thus necessary to quantify key health outcomes associated with public health impact and the ability to reach priority populations for services and appropriate follow-up - so as to identify drivers and demonstrate the cost-effectiveness of integrated programmes.
These metrics coupled with qualitative insights from targeted audiences highlight women’s needs and barriers to accessing integrated services and how these may differ contextually.
There are several unresolved operational questions related to how to best deliver high quality, integrated services to girls and women in need across LMICs, even as various programmes drive integrated service delivery.
Existing communities should be engaged and supported to evaluate and document which integrated service delivery models are feasible, acceptable, and sustainable given the realities of human resource capacity and other health system constraints.
There is also an opportunity to leverage existing investments and political momentum of global initiatives such as FP2020, 90-90-90 targets in HIV, and the WHO's global call to action for cervical cancer elimination to broaden support for integrated service delivery models.
These are the actions of our generation that will set the foundation for the elimination of cervical cancer.
Reproductive health manager, Population Services Kenya
