Multimodality screening and prevention of cervical cancer in sub-Saharan Africa: a collaborative model

Curr Opin Obstet Gynecol. 2020 Feb;32(1):28-35. doi: 10.1097/GCO.0000000000000597.

Abstract

Purpose of review: Although cervical cancer continues to decrease in incidence throughout the developed world because of rigorous screening and vaccination campaigns, the disease remains a major cause of cancer-related morbidity and mortality in resource-limited regions including sub-Saharan Africa. This review summarizes current efforts to implement cost-effective and widespread cervical cancer education, screening, and community-based interventions in Africa and the challenges faced by local healthcare workers.

Recent findings: Effective screening with cytology (with or without high-risk human papillomavirus [HPV] DNA testing) as well as HPV self-sampling remains problematic in African countries because of a paucity of cytopathologists and resources. Accordingly, visual inspection of the cervix with acetic acid (VIA) with cryotherapy triage has gained traction in mass-screening campaigns because of low-cost supplies.

Summary: Public education to facilitate screening is essential. VIA remains a strong community-based approach. The involvement of technology in teaching local providers, advertising screenings to the community, and helping improve follow-up may also improve screening efforts. Ultimately, the best form of prevention is through HPV vaccination, which also requires implementation of ongoing public education programs.

Publication types

  • Review

MeSH terms

  • Africa South of the Sahara
  • Community Health Services / organization & administration
  • Early Detection of Cancer / economics
  • Early Detection of Cancer / methods*
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Mass Screening / economics
  • Mass Screening / methods*
  • Papanicolaou Test
  • Papillomavirus Infections / diagnosis*
  • Papillomavirus Vaccines / administration & dosage
  • Physical Examination / methods
  • Physical Examination / statistics & numerical data
  • Uterine Cervical Neoplasms / prevention & control*

Substances

  • Papillomavirus Vaccines