March 8th is International Women’s Day. This year’s theme is Each for Equal, recognising that an equal world is an enabled world. Cervical cancer is the fourth most common cancer in women globally. In 2018, an estimated 570,000 women were diagnosed with cervical cancer worldwide, and about 311,000 women died from the disease. Cervical cancer is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively.
No woman should die from cervical cancer; we have the necessary tools to eliminate it. The burden of cervical cancer falls on the women who lack access to health services, mainly in low- and middle-income countries. Most new cervical cancer cases are in Asia (55%) and Africa (21%). With a comprehensive approach to prevent, screen, and treat, cervical cancer can be eliminated as a public health problem within a generation.
Bhutan aims to eliminate cervical cancer by 2030. To achieve this goal, a team of cyto technicians from six districts in Bhutan visited Sri Lanka for training on cyto-screening. The training was organised by WHO Sri Lanka, the Family Health Bureau, and the College of Pathologists of Sri Lanka as a South-South collaboration. It focused on practical skills development and quality assurance; enabling participants to refresh their skills and explore the Sri Lankan health system. The experience highlighted essential tools to eliminate cervical cancer in Bhutan.
South-South collaborations allow countries to learn from each other and maximise their skill sets to achieve local and universal goals. For example, in Bhutan, both married and unmarried women of eligible age who are sexually active are encouraged to get screened, and services are provided without discrimination. This kind of programme is critical to eliminating cervical cancer.
Sri Lanka’s initiatives to address cervical cancer have been successful because the country offers community-based screening. Dr Loshan Moonesinghe, the focal point for the Well Women Program and a Consultant Community Physician at the Family Health Bureau, explained that the Well Women Program screens women for breast, thyroid, and cervical cancer at ages 35 and 45, in-line with WHO recommendations. Dr Priyani Amaratunga, a Consultant Histopathologist at the Family Health Bureau, added that since services are at the village-level, Sri Lanka’s dense network of Public Health Midwives can reach all corners of the island. All eligible females are contacted for appropriate screenings; however, the screening participation rate for cervical cancer in Sri Lanka is only 50 – 70%.
Sri Lanka’s community-based screening programs and high vaccination rates reflect the country’s leadership in the region on eliminating cervical cancer. Sri Lanka has the lowest incidence of cervical cancer in South-Central Asia, however, the country’s incidence rate is still well above the incidence rate of less than 4 cases per 100,000 women, which is the rate required to eliminate cervical cancer as a public health problem. Since almost all cervical cancer cases (99%) are linked to infection with high-risk human papillomaviruses (HPV), Sri Lanka must maintain their extensive vaccination programs. Similarly, the country should prioritise expanding the reach of and buy-in to existing, widespread, screening programs. With a concerted effort, Sri Lanka can embrace the each for equal theme and help the world eliminate cervical cancer within the lifetime of today’s young girls.
