Cancer of the cervix in the African Region: current situation and way forward

Abstract

BACKGROUND 1. Cancer of the cervix is the commonest cancer and the leading cause of cancer mortality among women in developing countries. According to WHO, in 2002, there were more than 500 000 new cases of cervical cancer worldwide, over 90% of which were recorded in developing countries. In sub-Saharan Africa, 72 000 new cases were recorded in the same year and 56 000 women died of the disease.1 2. High incidences of cervical cancer are reported in Africa at rates exceeding 50 per 100 000 population and age-standardized mortality sometimes exceeding 40 per 100 000 population (see Table attached). For example, between 1981 and 1990, data from Nairobi hospital records showed that cervical cancer accounted for 70%–80% of all cancers of the genital tract and 8%–20% of all cancers.2 3. The major risk factor associated with cervical cancer is human papillomavirus (HPV) infection which generally occurs in adolescence after the first acts of sexual intercourse. In Africa, HPV infection prevalence is estimated at 21.3%, with significant variations from region to region: 33.6% in East Africa, 21.5% in West Africa and 21% in Southern Africa.3 Other major risk factors include tobacco use and lack of screening and adequate treatment of precancerous lesions. Human papillomavirus and human immunodeficiency virus (HIV) coinfection accelerates progression towards cancer. 4. Primary prevention of cervical cancer is based essentially on healthy lifestyles and vaccination against HPV. Two types of vaccines against HPV infection are currently available on the market: one acts against HPV genotypes 6, 11, 16 and 18 (quadrivalent vaccine) and the other against genotypes 16 and 18 (bivalent vaccine).4 5. Secondary prevention of cervical cancer is by screening for precancerous lesions and early diagnosis followed by adequate treatment. The main techniques used are cytological screening of cervical cells and visual inspection of the cervix. Pilot projects initiated in six countries5 of the African Region and coordinated by WHO have shown the efficacy, safety and effectiveness of visual inspection as a method of screening.6