Visualizing cervical cancer: Leading killer of African women

Cervical cancer, usually caused by vaccine-preventable human papillomavirus (HPV), is a leading killer of young women in Africa. WHO photo

Cervical cancer is the leading cause of cancer death for women in 40 of the 48 countries of sub-Saharan Africa, according to the most reliable health statistics.

In high-income countries, cervical cancer ranks in the bottom half of all new cancer cases – below gallbladder, mouth, or brain cancers. In places like Ethiopia, Ghana, and Uganda, and 20 other African countries, according to 2013 health surveys, it is the most commonly diagnosed cancer among women.

Until the middle of the 20th century, cervical cancer was a leading cause of cancer death for women in the United States and elsewhere. The main driver of the major declines in cervical cancer deaths witnessed in developed countries was the introduction and implementation of screening, in the form of Pap testing, beginning in the 1950s.

This screening approach, which involves an office visit followed by treatment or surgery if needed, has been one of the most successful cancer screening programs in history. However, this multi-step approach to screening and care is not as optimal in many African countries, where out-of-pocket costs and long distances to health services can both be substantial impediments for women.

Probability of dying from cervical cancer among women aged 15 to 49, 2013

Cervical Cancer IHME Source: Global Burden of Disease 2013. To explore the data visualization online, go to http://ihmeuw.org/3id7.

During the last 15 years, substantial efforts have been made toward finding better alternatives to cervical cancer screening in low-resource settings. Visual inspection with acetic acid, or VIA, is one such alternative: It requires only a brief training, so it can be conducted by physicians, nurses, or midwives; and treatment can be provided during the same visit as the screening, so that women are not required to make multiple trips. This kind of “screen-and-treat” program has been estimated to cost less than $10 per woman screened to begin to substantially decrease cervical cancer deaths in sub-Saharan African countries.

At the same time that evidence-based alternatives to Pap screening were being developed, the HPV vaccine, which prevents the human papillomavirus types that cause most cervical cancers, became available. Leaders in Africa and elsewhere have recognized the HPV vaccine as a game-changer with the potential to radically decrease the risk of cervical cancer across whole populations.

In 2010, seven African first ladies issued a statement calling for increased access to HPV vaccination and cancer screening. Progress is underway in many countries. Uganda, for example, is preparing to introduce the HPV vaccine nationwide in 2015; Mozambique is conducting a demonstration project in preparation for national rollout in the next few years; and Rwanda, where adult women had the second-highest probability of dying from cervical cancer in 1990, was the first African country to introduce universal HPV vaccine coverage, in 2011.

Last week, 30 African First Ladies gathered to discuss how their countries are doing tackling one of the continent’s growing challenges: cancer, and particularly the rising burden of breast, cervical, and prostate cancers.

Cervical cancer has become a success story in much of the world. As prevention efforts continue to expand and gain traction, there is no reason this won’t be the case in sub-Saharan Africa as well.

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About Author

Amy VanderZanden

Amy VanderZanden is a communications data specialist at the University of Washington’s Institute for Health Metrics and Evaluation (IHME).

  • neo paré

    South Africa started vaccinating all Grade 4 (i.e. 9 years and up) girls last year for HPV and has acheived about 95% coverage. Worth mentioning.

  • Prevention of cervical cancer is well publicized (as above). Prevention of bowel cancer – by finding and removing pre-cancerous “polyps” during a colonoscopy – is not so well publicized. Hence, in most places, bowel cancer kills more women than cervical cancer. (Google “Don’t get fined $35,000+ for missing a colonoscopy”.)

  • Helen Olsen

    Thanks so much for writing about this important issue, Amy! I’m just finishing preliminary fieldwork to prepare for my doctoral research on cervical cancer screening in East Africa next year. It’s rare to find a blog post that so systematically communicates both the burden of disease in Sub-Saharan Africa, as well as the need for alternative diagnostic technologies that fit better in resource-limited clinical contexts. It’s really lovely to find that your posts so far have addressed issues of chronic disease, which often go vastly under discussed.

    • Erica Kristen

      Helen, I am in the exact same situation as you. I am in the midst of my preparatory fieldwork to prepare for my doctoral research on cervical cancer screening in Tanzania. Would love to chat and hear what you are working on!