Just a few days prior to the World Health Assembly (which is taking place this week, 21st-26th May 2018), the Director-General of the WHO, Dr Tedros Adhanom Ghebreyesus made a global call for action towards a disease that can be eliminated - cervical cancer. He expressed the need for global coordinated action of multilateral agencies and the private sector, who are the manufacturers of vaccines, diagnostics, and treatments.
Cervical cancer is one of the most preventable and treatable forms of cancer if detected and managed early. Yet one woman dies of cervical cancer every two minutes and of those that die, 9 in 10 live in poor countries. The Human Papilloma Virus (HPV) vaccine is very effective and has the ability to save millions of lives (as nearly all cases of cervical cancer are caused by HPV), but access is problematic. Dr Tedros has called for all girls globally to be vaccinated against HPV and that every woman over 30 years is screened and treated for pre-cancerous lesions.
Cervical cancer is a disease of poverty. It is largely preventable through public health interventions such as screening and the HPV vaccination. However, where a woman lives (her country, rural or urban), her socioeconomic status, her status within the family, and the culture she is exposed to will determine whether she develops cervical cancer. These factors will influence how early she presents, and whether she has access to preventative, diagnostic and treatment services.
The decline in cervical cancer incidence and mortality rates seen recently, are due to high income countries effectively implementing screening programs and increasing access to HPV vaccines. Although these countries have strong health systems, they also appear to significantly consider the lives of girls and women within public health policy. These countries with high human development (an index based on lifespan, education and GDP per capita) tend to have less gender inequality. In fact, the Gender Inequality Index (which includes the status of reproductive health, women’s empowerment, and economic status) has shown to be correlated with cervical cancer incidence and mortality. The higher the inequality, the higher the risk of developing and dying from cervical cancer. This means it is not enough for countries to solely focus on strengthening health systems, enhancing supplies or creating access. There is also a need to look at the status of girls and women. Even if there is access to screening, there are still barriers such as lack of privacy, embarrassment, and health care personnel attitudes that greatly affect women’s use of these services.
Elimination of cervical cancer is not just about partnering with the private sector to increase vaccine supplies, or the development of government screening programs. Screening has to be present with access to the right treatment (such as radiotherapy services of which there is a worldwide shortage), as well as removal of barriers mentioned above. This is particularly vital for those women who already have HPV. We will continue to fail women if we screen them when treatment is not available, or if they feel they cannot access care because they do not trust the health system.
Dr Tedros has highlighted that there is a great urgency to eliminate cervical cancer. However, as well as collaboration, individual governments have to help remove barriers women face when accessing care. Governments need to agree that women’s lives are worth saving, and this requires girls and women to be considered at all levels of decision making, from policy making to point of care delivery.
Identification of anemia in pregnant women is important, since it is an important cause of multiple complications during pregnancy (preterm delivery, low birth weight and perinatal death), so it is recommended to all pregnant women, in the first prenatal visit and at 28 weeks of gestation, the measurement of serum concentrations of hemoglobin and hematocrit as a screening test for anemia.
Prenatal assessment seeks to identify, through clinical history, sociodemographic characteristics, mean blood pressure, Doppler of the uterine arteries and biochemical markers such as pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PlGF), those women who are at high risk of developing preeclampsia in order to take appropriate measures. that can help reduce that risk.