Prevention and detection of cervical cancer across Africa

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Published: 20 Nov 2017
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Dr Lynette Denny - Groote Schuur Hospital, Cape Town, South Africa

Dr Denny speaks with ecancer at AORTIC 2017 about detection and prevention of cervical cancer in developing economies.

By comparison to Pap smears, which she describes as hard to maintain as a prevention scheme without supporting infrastructure, Dr Denny outlines how HPV testing and vaccination might help disease detection and prevention.

Cervical cancer has been known to be a preventable disease since the 1940s through the Pap smear and any countries that were able to institute Pap smear screening programmes dramatically reduced the incidence of cervical cancer. But very few developing countries, in fact none that I know of, have managed to initiate, sustain or maintain cervical cancer screening programmes because it’s complex and it requires a very well-functioning referral system and infrastructure. When you’ve got competing health needs, such as those that I’ve mentioned before, it’s very difficult. So you find the poorer the country the more likely that you’re going to be dealing with trying to cure disease because everyone is acute whereas in the wealthier countries they actually have excess cash and they can put it into prevention programmes.

I’ve been working on looking for a more technologically friendly protocol for preventing cervical cancer. Essentially where we have come to now is that there is a test for human papilloma virus which is the cause of cervical cancer, certain types, which can give you a result in an hour, just like a point of care test. So you can go out into a clinic, it doesn’t require trained laboratory assistants, you can do the test and you can train a nurse that if her test is positive she can burn or freeze or various treatments to remove precancerous cells. That has been shown to prevent cervical cancer. So that’s my current research but we’ve been doing this for twenty years to prove that you can actually ditch cytology for human papilloma virus testing.

Will the situation get better when vaccines are rolled out?

It will, it’s just going to take a long time because HPV associated disease, which is not only cervix but it’s also the vulva, vagina, penis, anus etc., has a long latent phase. So you can get infected, say, at the age of 28 but only manifest your cancer at the age of 50. So for us to vaccinate nine year olds and actually really see an impact on cervical cancer reduction is going to take a number of years. But as of March 2017 71 countries have introduced HPV vaccination into their immunisation programmes and eleven countries have extended it from girls to boys. So it’s getting out there.

In an ideal world should it be for boys as much as girls?

Yes. It’s a resource issue. So in an ideal world definitely I would vaccinate boys.