In an ongoing effort to reduce cervical cancer deaths among women in the developing world, Jhpiego experts reached out to a formidable ally in Thailand and the Philippines—mothers.
The aim of the Mother-Daughter Initiative was to educate mothers about a leading cause of cervical cancer, the sexually transmitted human papillomavirus (HPV), and to protect the next generation of women by vaccinating young girls, ages nine to 13, against HPV. Jhpiego and partners chose Thailand and the Philippines for the mother-daughter demonstration project and research study because of the strong networks of community health volunteers and cervical cancer prevention programs under way in both countries.
Jhpiego conducted the study in collaboration with Merck and Co., the Cancer Institute Foundation of the Philippines, Chulalongkorn University in Thailand and leading cervical cancer experts in the respective countries. Merck & Co. supported the study with a research grant and provided the HPV vaccine.
Cervical cancer kills about 274,000 women a year, the majority of whom live in the developing world, where Pap tests—the screening method used in developed countries—are costly and not easily accessible. The number of women in Thailand and the Philippines who are newly diagnosed with cervical cancer every year is much higher than in the United States (Thailand, 25 per 100,000 women; the Philippines, 12 per 100,000; United States, 6 per 100,000) (GLOBOCAN 2008).
Jhpiego has been working in cervical cancer prevention in Thailand for the past decade. In 2005, the Philippine Government made a commitment to improve cervical cancer screening services in its country, where the mortality rate from cervical cancer, 15.6 per 100,000, exceeds those of Thailand (8.4) and the United States (2.6). Jhpiego previously helped implement a cervical cancer screening and treatment program in eight sites across the country, with more than 10,000 women receiving services.
Dr. Ricky Lu, Jhpiego’s cervical cancer prevention expert, said the study focused on girls between ages nine and 13—before they become sexually active—because the HPV vaccine is not as effective once a girl or woman has contracted the virus. Girls whose mothers agreed to enroll them in the project received cervical cancer screening and treatment services as part of the study.
During the two-year project, 8,005 adolescent girls participated in the study: 4,005 in Thailand and 4,000 in the Philippines—99.8 percent (3,997) of the girls in Thailand and 88.1 percent (3,524) of the girls in the Philippines completed all three doses of the HPV vaccine.
“The other underlying goal is to use the data to assist the governments of Thailand and the Philippines to develop their own policies and guidance for introducing the HPV vaccine,” says Lu.
Approximately one-quarter of Thailand’s 65.7 million people are under the age of 13. In the Philippines, the numbers are greater, at 35 percent of the population of 88.7 million. The Mother-Daughter Initiative has the potential to help millions of women by working to protect the health of the next generation.
“Education about cervical cancer must be ongoing,” Lu says. “Even if you are vaccinated, there is a need for screening. The vaccine is going to protect you only to a certain extent. When you reach a certain age, you still need to be screened.”