Cervical cancer has a significant global impact, with 490,000 new cases and 270,000 deaths each year. 85% of cervical cancer deaths occur in developing countries. There is a large geographical variation in incidence and mortality rates, with the highest rates found in central South America, sub-Saharan Africa, India, and Southeast Asia. HPV types 16 and 18 cause 70% of cervical cancer cases. Cervical cancer develops over 15-20 years, from HPV infection to precancer to invasive cancer. Prevention strategies include HPV vaccination and cervical cancer screening.
Cervical cancer has a significant global impact, with 490,000 new cases and 270,000 deaths each year. 85% of cervical cancer deaths occur in developing countries. There is a large geographical variation in incidence and mortality rates, with the highest rates found in central South America, sub-Saharan Africa, India, and Southeast Asia. HPV types 16 and 18 cause 70% of cervical cancer cases. Cervical cancer develops over 15-20 years, from HPV infection to precancer to invasive cancer. Prevention strategies include HPV vaccination and cervical cancer screening.
Cervical cancer has a significant global impact, with 490,000 new cases and 270,000 deaths each year. 85% of cervical cancer deaths occur in developing countries. There is a large geographical variation in incidence and mortality rates, with the highest rates found in central South America, sub-Saharan Africa, India, and Southeast Asia. HPV types 16 and 18 cause 70% of cervical cancer cases. Cervical cancer develops over 15-20 years, from HPV infection to precancer to invasive cancer. Prevention strategies include HPV vaccination and cervical cancer screening.
Cervical cancer has a significant global impact, with 490,000 new cases and 270,000 deaths each year. 85% of cervical cancer deaths occur in developing countries. There is a large geographical variation in incidence and mortality rates, with the highest rates found in central South America, sub-Saharan Africa, India, and Southeast Asia. HPV types 16 and 18 cause 70% of cervical cancer cases. Cervical cancer develops over 15-20 years, from HPV infection to precancer to invasive cancer. Prevention strategies include HPV vaccination and cervical cancer screening.
490,000 new women each year with more than 270,000 deaths.
About 85 percent of women dying
from cervical cancer reside in developing countries.
Transcript: Worldwide, cervical cancer affects 490,000 new women each year, with more than 270,000 deaths. About 85 percent of women dying from cervical cancer reside in developing countries of the world.
The Global Impact of Cervical Cancer—2
Number of cases and incidence of cervical cancer
Source: Ferlay J, Bray F, Pisani P, Parkin DM; International Agency for Research on Cancer (IARC). GLOBOCAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide. Lyon, France: IARCPress; 2004; CancerBase No. 5, version 2.0.
There is a unique geographical distribution which has been published by a group
called Globocan to estimate the amount of cases and incidence of cervical cancer.
The uniqueness is that cervical cancer incidence is highly concentrated in the
southern part of the hemisphere. The highest concentration is in central South America which constitutes about 71,000 cases a year, and sub-Saharan Africa constitutes 78,000 a year, followed by India and Southeast Asia, which also has 260,000 cases occurring in a year. The lowest incidence for this cancer occurs in North America, Europe, and Australia. This is really a result of programs in those countries which aim to attract women for cervical cancer screenings through Pap smears and subsequently identify precancerous cells which are treated to protect the women from getting cervical cancer.
The Global Impact of Cervical Cancer—3
Cervical cancer mortality rates per 100,000 women
Source: Ferlay J, Bray F, Pisani P, Parkin DM; International Agency for Research on Cancer (IARC). GLOBOCAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide. Lyon, France: IARCPress; 2004; CancerBase No. 5, version 2.0.
Age-specific cervical cancer mortality rates per 100,000 women again show us another disparity between less developed countries and developed countries. If we look at the age between 45 and 54, almost five times more women were dying in the less-developed countries compared to the developed countries. The same pattern is replicated among women 55 to 64 years of age and this pattern really is a typical example of health care delivery systems whereby in the less-developed countries things like surgical care, radiotherapy, and chemotherapy are less available to women with cancer compared to their counterparts in developed countries.
The Global Impact of Cervical Cancer—4
Stigma and loneliness
Women with cervical cancer often suffer pain, and face death, isolated from family and friends.
Cervical cancer is a very unique disease in that the part of the body that it strikes creates an environment where stigma and loneliness become a feature that we see. Women with cervical cancer often suffer from pain, particularly in our countries of low income, where morphine and palliative care is not regularly available. So you’ll find that because of the discharge occurring in these women, they do have an odor coming out. Experiences have shown, even on my ward in Harare, where I work, when I have medical students and nursing staff, we’ll have patients on the ward, but we can tell before we enter the cubicle that we are really dealing with a case of cervical cancer, because the smell coming out is quite unbearable. And the patients, quite often they isolate themselves, because they know what’s coming out due to this chronic discharge, and the fear of death is right there in their face. And quite often, because of the isolation, they don’t want their family members to know what is embarrassingly coming out and they may live in a remote part of the home or even leave the home environment and stay out in the bush.
So it is indeed a very sad world for all of us who really care for them and we know, because again, they attend our institutions with advanced disease and you know you can’t give them curative care. Lack of things like morphine make it a very difficult environment to work with. We try very hard to counsel the patient and family members to provide terminal care at home.
The Global Impact of Cervical Cancer—5
HPV-cervical cancer link HPV (human papillomavirus) is the primary cause of cervical cancer.
Two HPV types—16 and
18—account for 70 percent of cervical cancer cases (though regional variations exist).
One of the most exciting developments that just occurred in the area of cervical cancer is the discovery of human papillomavirus over the past three decades. We’ve known that there are at least 100 types of human papillomavirus. Forty of them will infect the genital tract, but of particular note is that, in terms of cervical cancer itself, a majority of cervical cancer cases—70 percent—are caused by human papillomavirus type 16 and 18 and this comes on a very strong background. We now have vaccines which are registered to prevent cervical cancer with these two types of HPV virus.
The Global Impact of Cervical Cancer—6
How cervical cancer develops
-------------------------------- 15–20 years --------------------------------
Source: Wright TC and Schiffman M. Adding a Test for Human Papillomavirus DNA to Cervical-Cancer Screening. The New England Journal of Medicine. 2003;348:489–490.
Some of the scientific findings over the past three decades tell us that human papillomavirus is a very common infection among women. In fact, it’s estimated that up to 70 percent of women will have acquired human papillomavirus in their lifetime. However, most women do not get the cancer. It’s the oncogenic, or the cancer- causing HPV 16 and 18, which tend to replicate. They affect the cervix and that replication process takes 10 to 15 years before the women develop advanced cancer. Now a window of opportunity for preventing cervical cancer is during the time that precancer cells are formed on the cervix, there are tests that can be offered; the Papanicolaou (Pap) smear (cervical cytology). If that is done and if normal cells are seen, the woman can be offered tests and treatments to avoid getting cervical cancer.
The Global Impact of Cervical Cancer—7
Cervical cancer prevention options
Primary prevention HPV vaccination prior to infection (before sexual life begins)
Secondary prevention Cervical cancer screening (women age 30+)
What options do we have to prevent cervical cancer? Well, we know that
widespread use of the vaccine alone will have a huge potential in reduction of cervical cancer. The estimate is that we could reduce 50 percent of these deaths over the next several decades. And then of course, what’s more exciting, is that if you combine improved prescreening for cervical cancer and vaccination, the mortality will further be reduced. You can learn more by watching the other videos.
