HARP Project

Cervical Cancer

Cervical cancer is a major public health problem in developing countries. Approximately 80% of cases worldwide occur in developing countries, where cervical cancer accounts for 15% of female cancers compared with just 3.6% in developed countries.

However, in the context of sub-Saharan Africa, cervical cancer is the most common cancer and the leading cancer-related cause of death among women. An estimated 70,700 annual new cases occur each year in sub-Saharan Africa, representing one quarter of all female cancers ( Parkin DM et al, 2008 ). The magnitude of the problem has been under-recognised and under-prioritised compared to competing health priorities such as HIV/AIDS, tuberculosis and malaria ( Louie KS et al, 2009 ). Most cases of women with cervical cancer in sub-Saharan Africa present at advanced stages of the disease, when treatment is ineffective or not available.

HPV cell Cervical cancer is caused by genital human papillomavirus (HPV) infection, the most common sexually transmitted infection among women.  Of the more than 100 types of HPV, only some cause cervical cancer; types 16 and 18 are found in 70% of cases of the cancer. Other types, such as 6 and 11, cause genital warts, and others are harmless.  Importantly, most people who become infected with HPV do not know they have it.

Cervical cancer is detectable and preventable through cervical screening for pre-cancerous lesions (Papanicolaou smear).  Such screening has been effective in preventing cervical cancer in industrialized countries, where adequate health infrastructure and human and finance resources are available to ensure high quality and good coverage.  However, this has largely failed in most developing countries where appropriate infrastructure is not achievable ( Denny L et al, 2006 ).

The availability of two effective prophylactic HPV vaccines gives new promise for a primary prevention strategy for HPV infection and cervical cancer.  However, these vaccines will not have an effective impact in developing countries until they are affordable and integrated within the framework of national immunisation programmes.

Top: cervical smear using Ayre’s spatula for ‘traditional’ cytology using Papanicolaou (pap) staining

Middle: normal cervix uteri seen through speculum examination: the mucosa is smooth, pink and shiny

Bottom: cervical lesion coloured in white after application acetic acid (aceto-white lesion)