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| See-and-treat approach can rein in Cambodia's cervical cancer death toll | See-and-treat approach can rein in Cambodia's cervical cancer death toll |
| (4 months later) | |
| Every year worldwide there are an estimated 530,000 new cases of cervical cancer. The disease kills 250,000 women a year, 85% of whom live in low- and middle-income countries, like Cambodia, where it is the country's most common cancer and killing more women than breast cancer or maternal mortality. | Every year worldwide there are an estimated 530,000 new cases of cervical cancer. The disease kills 250,000 women a year, 85% of whom live in low- and middle-income countries, like Cambodia, where it is the country's most common cancer and killing more women than breast cancer or maternal mortality. |
| Cambodia has no screening programme for cervical cancer to identify the approximately 1,500 women newly infected each year, and no treatment apart from palliative care for the 900 women or more who die after a long and painful illness from a largely preventable disease, often robbing families of both a mother and economic provider. | Cambodia has no screening programme for cervical cancer to identify the approximately 1,500 women newly infected each year, and no treatment apart from palliative care for the 900 women or more who die after a long and painful illness from a largely preventable disease, often robbing families of both a mother and economic provider. |
| As the country begins to grapple with its growing burden of non-communicable diseases, cervical cancer is now on the public health agenda, and has been described by the government as the most urgent priority for cancer screening. | As the country begins to grapple with its growing burden of non-communicable diseases, cervical cancer is now on the public health agenda, and has been described by the government as the most urgent priority for cancer screening. |
| Non-communicable diseases were one of the country's top four health priorities in the health strategic plan for 2008 to 2012 (pdf), and a new draft national strategic plan for the prevention and control of non-communicable diseases recognises that cervical cancer screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy is one of the 'best buys' for low- and middle-income countries, costing less than $1 per person per year. Cambodia's plan targets at least 60% of women aged 35 to 49 being screened for the disease by 2020. | Non-communicable diseases were one of the country's top four health priorities in the health strategic plan for 2008 to 2012 (pdf), and a new draft national strategic plan for the prevention and control of non-communicable diseases recognises that cervical cancer screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy is one of the 'best buys' for low- and middle-income countries, costing less than $1 per person per year. Cambodia's plan targets at least 60% of women aged 35 to 49 being screened for the disease by 2020. |
| With the support of several international agencies, in August this year pilot programmes will get underway to test VIA and cryotherapy with a view to finding which approach will work best for the country as a whole. The project will be able to take lessons learned from earlier pilot studies run in Africa, as well as learning from on-going programmes in neighbouring Vietnam, and in time will itself add to the body of knowledge on using this relatively simple intervention in low-income settings elsewhere in the world. | With the support of several international agencies, in August this year pilot programmes will get underway to test VIA and cryotherapy with a view to finding which approach will work best for the country as a whole. The project will be able to take lessons learned from earlier pilot studies run in Africa, as well as learning from on-going programmes in neighbouring Vietnam, and in time will itself add to the body of knowledge on using this relatively simple intervention in low-income settings elsewhere in the world. |
| "Many low-income countries are moving towards marked revisions in their national programmes based on single visit or screen-and-treat approaches using VIA and cryotherapy," says Dr Khim Sam Ath, technical officer for non-communicable diseases at the World Health Organisation's representative office in Cambodia. "This approach has been successfully used in Thailand, Indonesia, Vietnam and the Philippines." | "Many low-income countries are moving towards marked revisions in their national programmes based on single visit or screen-and-treat approaches using VIA and cryotherapy," says Dr Khim Sam Ath, technical officer for non-communicable diseases at the World Health Organisation's representative office in Cambodia. "This approach has been successfully used in Thailand, Indonesia, Vietnam and the Philippines." |
| A single visit see-and-treat approach eliminates the risk of loss to follow-up, a particular problem in countries like Cambodia where there is no referral system. The Cambodian ministry of health introduced cervical cancer screening using VIA two years ago, there was no systematic follow-up afterwards. However, the government-run pilot study will continue to screen and refer, as it has the advantage of being able to spread screening services, conducted by midwives, across a larger number of health care centres, referring cases for treatment to hospital. | A single visit see-and-treat approach eliminates the risk of loss to follow-up, a particular problem in countries like Cambodia where there is no referral system. The Cambodian ministry of health introduced cervical cancer screening using VIA two years ago, there was no systematic follow-up afterwards. However, the government-run pilot study will continue to screen and refer, as it has the advantage of being able to spread screening services, conducted by midwives, across a larger number of health care centres, referring cases for treatment to hospital. |
| At the same time, the programme run by Marie Stopes International (MSI) will be operated via one of its existing clinics and an outreach clinic on a see-and-treat basis. "In our pilot area we are working with midwives linked with doctors on-site, for immediate treatment, says Dr Antoinette Pirie, health adviser at Marie Stopes International Cambodia. | At the same time, the programme run by Marie Stopes International (MSI) will be operated via one of its existing clinics and an outreach clinic on a see-and-treat basis. "In our pilot area we are working with midwives linked with doctors on-site, for immediate treatment, says Dr Antoinette Pirie, health adviser at Marie Stopes International Cambodia. |
| "At the moment Marie Stopes International is the main social provider of reproductive health services in Cambodia and this programme fits well with that. If you're providing family planning, it's very easy to add this on and you're missing an opportunity by not doing it. MSI in Vietnam is already doing this through 600 clinics, so we will have a study tour there to learn from them too," says Pirie. | "At the moment Marie Stopes International is the main social provider of reproductive health services in Cambodia and this programme fits well with that. If you're providing family planning, it's very easy to add this on and you're missing an opportunity by not doing it. MSI in Vietnam is already doing this through 600 clinics, so we will have a study tour there to learn from them too," says Pirie. |
| A third pilot is also expected to get underway this year, run by a consortium led by Epos Health Management using a vouchers system under the second phase of an existing programme. | A third pilot is also expected to get underway this year, run by a consortium led by Epos Health Management using a vouchers system under the second phase of an existing programme. |
| "At this moment, only and incidentally opportunistic screening is done in the project's core provinces and on a very limited scale," says Dr Marcel Reyners, Vouchers for Reproductive Health Services project team leader for KfW, the German government-owned development bank involved in the project. "The population-based approach tailored to the needs and possibilities of Cambodia can eliminate invasive cancers and save lives of many women at low cost." | "At this moment, only and incidentally opportunistic screening is done in the project's core provinces and on a very limited scale," says Dr Marcel Reyners, Vouchers for Reproductive Health Services project team leader for KfW, the German government-owned development bank involved in the project. "The population-based approach tailored to the needs and possibilities of Cambodia can eliminate invasive cancers and save lives of many women at low cost." |
| Further down the line, Cambodia may introduce human papillomavirus (HPV) vaccination to prevent cervical cancer, but the vaccine is currently unavailable via the public health system and is prohibitively expensive for most women and girls there. Although Cambodia is eligible for new vaccines co-funding from the Gavi Alliance, HPV vaccination projects will only be supported if the government can prove it has already successfully rolled out a pilot study. There are no plans to do this until 2016 at the earliest and a vaccination will take two decades to show results. | Further down the line, Cambodia may introduce human papillomavirus (HPV) vaccination to prevent cervical cancer, but the vaccine is currently unavailable via the public health system and is prohibitively expensive for most women and girls there. Although Cambodia is eligible for new vaccines co-funding from the Gavi Alliance, HPV vaccination projects will only be supported if the government can prove it has already successfully rolled out a pilot study. There are no plans to do this until 2016 at the earliest and a vaccination will take two decades to show results. |
| In the meantime, see-and-treat programmes can start saving lives as early as this August. The pilot programme also has linkages with overall health systems strengthening because all enrolled sites will be able to set up a follow-up registry for women who have positive VIA test results by feeding data into a broader e-health initiative, said Dr Jerker Liljestrand, programme leader at URC Better Health Services Cambodia. "URC is helping Cambodia's ministry of health develop its health management system using an internet-based solution, so we can just add this as another component." | In the meantime, see-and-treat programmes can start saving lives as early as this August. The pilot programme also has linkages with overall health systems strengthening because all enrolled sites will be able to set up a follow-up registry for women who have positive VIA test results by feeding data into a broader e-health initiative, said Dr Jerker Liljestrand, programme leader at URC Better Health Services Cambodia. "URC is helping Cambodia's ministry of health develop its health management system using an internet-based solution, so we can just add this as another component." |
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