Feature - Groundbreaking global meeting on cervical cancer prevention convened by Jhpiego

In December 2005, in collaboration with Chulalongkorn University Faculty of Medicine, Jhpiego hosted a global meeting in Bangkok, Thailand, to address cervical cancer prevention in low-resource settings. With funding from the Bill & Melinda Gates Foundation, GlaxoSmithKline and Digene, "Preventing Cervical Cancer: From Research to Practice" was attended by 130 participants from 25 countries, including India, Indonesia, Ghana, South Africa, Ethiopia, Bangladesh, Malawi, Nepal and Bhutan.

The speakers' panel featured the leading experts in cervical cancer prevention, including presenters from Jhpiego, The Johns Hopkins University School of Medicine, the World Health Organization (WHO) and Chulalongkorn University Faculty of Medicine.

While Pap smears remain the most common method to detect cervical cancer, this test is often too expensive and impractical in developing countries, where cervical cancer is the leading cause of death in women. After successful prevention pilot programs in Thailand and Ghana, Jhpiego was eager to share the innovative prevention strategies with the international public health community.

Panelists discussed state-of-the-art interventions and innovative approaches to prevention, such as the evidence-based "single visit approach." This approach, using Visual Inspection with Acetic acid (VIA) linked with cryotherapy treatment, has been shown to be safe, acceptable, feasible and cost-effective. Also highlighted were the challenges of bringing care to vulnerable populations and best practices for implementing high-quality, sustainable prevention programs.

Jhpiego has been working collaboratively on cervical cancer prevention in Thailand and Ghana since 1999. During that time, the number of women being screened with VIA in Thailand jumped from only 5 percent to as high as 80 percent in some districts with more than 150,000 women being screened. Ghana had less than 1 percent of women screened annually and now over 15,000 have received screenings. As a result of these demonstration projects, both Thailand and Ghana have endorsed the “single visit approach” as an alternative to cytology-based screening.

Five years ago, Jhpiego's clinical staff met Fatima in Accra, Ghana. At the time she was 37 years old and had given birth five times without ever having a pelvic exam or being tested for cervical cancer. After learning of Jhpiego’s Cervical Cancer Prevention Program (CECAP), she traveled to Ridge Hospital for an exam. Fatima was the first cancer case to be identified in the Ghana pilot program. In most developing countries, the diagnosis would have been her epitaph; however, with funding from the Bill & Melinda Gates Foundation and through the Alliance for Cervical Cancer Prevention, Jhpiego’s staff provided Fatima with treatment and eventually a clean bill of health.

In the words of Dr. Paul Blumenthal, Professor at the Johns Hopkins University School of Medicine, "cervical cancer prevention [in low-resource settings] is not about doing the best test. It is about doing the best test that you can do." Likewise, he commented that, "testing by itself has no intrinsic preventive value. It is only by linking testing to treatment that you close the circle of prevention."

According to many participants, one of the most helpful conference sessions was the hands-on skills lab that taught the two techniques used in Jhpiego's single visit approach—visual inspection with Acetic Acid (VIA) and cryotherapy. All agreed that the action plan development session, bringing together the country and regional representatives, was instrumental in laying out the next steps to ignite action within respective institutions, programs, ministries of health and development partners.

As a result of the global meeting, Jhpiego is helping several countries, such as Thailand, Malawi, the Philippines and Indonesia, explore development of new cervical cancer prevention programs. In addition, there is the possibility of expanded donor support for Jhpiego’s Ghana program, and USAID/Malawi has approved a one-year extension of Jhpiego's ongoing cervical cancer prevention program there.