title: Challenges in Prevention and Care Delivery for Women with Cervical Cancer in Sub-Saharan Africa.
abstract: Virtually all cases of invasive cervical cancer are associated with infection by high-risk strains of human papilloma virus. Effective primary and secondary prevention programs, as well as effective treatment for early-stage invasive cancer have dramatically reduced the burden of cervical cancer in high-income countries; 85% of the mortality from cervical cancer now occurs in low- and middle-income countries. This article provides an overview of challenges to cervical cancer care in sub-Saharan Africa (SSA) and identifies areas for programmatic development to meet the global development goal to reduce cancer-related mortality. Advanced stage at presentation and gaps in prevention, screening, diagnostic, and treatment capacities contribute to reduced cervical cancer survival. Cost-effective cervical cancer screening strategies implemented in low resource settings can reduce cervical cancer mortality. Patient- and system-based barriers need to be addressed as part of any cervical cancer control program. Limited human capacity and infrastructure in SSA are major barriers to comprehensive cervical cancer care. Management of early-stage, locally advanced or metastatic cervical cancer involves multispecialty care, including gynecology oncology, medical oncology, radiology, pathology, radiation oncology, and palliative care. Investment in cervical cancer care programs in low- and middle-income countries will need to include effective recruitment programs to engage women in the community to access cancer screening and diagnosis services. Though cervical cancer is a preventable and treatable cancer, the challenges to cervical control in SSA are great and will require a broadly integrated and sustained effort by multiple stakeholders before meaningful progress can be achieved.
authors.affiliation: Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA, USA; Global Oncology Initiative, Harvard Cancer Center, Boston, MA, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Randall
authors.affiliation: Division of Gynecologic Oncology, University of Minnesota Medical School, Duluth, MN, USA; Human Resources for Health Program Rwanda, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Rahel
authors.initials: R
authors.lastname: Ghebre
keywords: cervical cancer; human resources; palliative care; radiation; sub-Saharan Africa; surgery