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Epidemiology and prevention of human papillomavirus and cervical cancer in sub-Saharan Africa: A comprehensive review
– Reported, 19 January 2013
Cancer of the cervix uteri is the most common cancer among women in sub-Saharan Africa (SSA). The magnitude of the problem has been under-recognized and underprioritized compared to competing health priorities such as HIV / AIDS, tuberculosis and malaria. This is due to lack of epidemiological data and poor awareness, lack of human and financial resources, non-existent cancer service policies and lack of political will to address the complex problem.
Organized screening and early treatment programmes have been effective in preventing cervical cancer in industrialized countries but they are costly and difficult to implement in resource-constrained settings. Despite our understanding of the causal relationship of the human papillomavirus (HPV) and cervical cancer and the availability of effective HPV vaccines to prevent infection and disease, the opportunity of these vaccines to have an effective impact in SSA will not materialize until they become affordable and integrated within the framework of national immunization programmes. Until then, cervical cancer prevention will rely on secondary prevention measures.
This review aims to summarize the current epidemiology of HPV and cervical cancer and the complexity of implementing prevention in sub-Saharan Africa; to identify gaps of knowledge and to highlight the challenges and opportunities for controlling cervical cancer in the region.
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Better cancer registry data to assess the burden of cervical cancer;
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Basic epidemiological data of HPV prevalence and genotype-distribution among women in the general population according to HIV serostatus to evaluate the potential impact of HPV vaccines and cervical cancer screening strategies;
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Longitudinal data on HIV infected women to evaluate the impact of ART on HPV infection and cervical disease;
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Long-term impact of HPV vaccines in preventing actual cases of cervical cancer.
Cervical screening:
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Evaluation of VIA, VILI in conjunction with HPV testing (e.g. with CareHPV) as screening tools in a screen-and-treat approach;
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Evaluation of screening strategies in HIV-positive populations, including those taking ART.
The burden of cervical cancer is potentially large in sub- Saharan Africa and there is an urgency to make it a public health priority. Sub-Saharan Africa is vastly heterogeneous and each country will need to decide on a realistically feasible cervical cancer prevention and control strategy. Existing data should be used to initiate plans and projects to better understand the current situation and programmes will need to take into consideration the impact of HIV co-infection to adequately address both health needs. The availability of low-cost cervical screening technologies of HPV testing and visual inspection methods and HPV vaccines represent tools that provide realistic opportunities for cervical cancer prevention in sub-Saharan Africa. In order to successfully introduce, implement and sustain a prevention programme, good data from across multidisciplines dedicated to the prevention of cervical cancer are needed.
CREDITS: Karly S. Louie , Silvia de Sanjose, and Philippe Mayaud
http://onlinelibrary.wiley.com/
