Cervical Cancer in Thailand
Cervical cancer is one of the greatest threats to women’s lives globally. With an estimated 570,000 new cases in 2018, it ranks as the fourth most frequent cancer in women. In the South-East Asia region, it is the third most common type of cancer. Last year, there were an estimated 158,000 new cases and 95,766 cervical cancer-related deaths in the region alone. The World Health Organisation (WHO) has urged the countries in this region to speed up their efforts to eliminate cervical cancer by 2030. Thailand, one of the countries in the South-East Asia region, has made great strides towards eliminating the disease in the past two decades. Here are seven facts about cervical cancer in Thailand.

7 Facts About Cervical Cancer

  1. Twenty years ago, cervical cancer was the most common cancer for women in Thailand. Currently, it is the second most frequent cancer among women in Thailand behind only breast cancer. It is estimated that every year 8,622 women are diagnosed with cervical cancer in Thailand and that 5,015 die from the disease.
  2. According to amfAR, the human papillomavirus (HPV) causes nearly all cervical cancer cases. This makes HPV the leading cause of cervical cancer among women in Thailand. Other factors that could cause cervical cancer are smoking, HIV and hormonal contraceptive use.
  3. In the last decade, cervical cancer in Thailand has seen the largest decline in incidence compared to the other four leading causes of cancer deaths for women. One can largely attribute this to the Safety, Acceptability, Feasibility and program implementation Effort (SAFE) which Thailand adopted in 2000.
  4. The SAFE approach is a single-visit method in which patients receive screening for cervical cancer and obtain treatment if necessary. This makes it cheaper than other screening methods since it does not require advanced equipment. The ease of implementation has seen 32 Thai provinces take up the SAFE approach.
  5. One reason the SAFE method yielded such great results was that nurses in the country were tasked with doing cryotherapy. This was important because, at the time, the ratio of doctors to patients was low at about one doctor per 60,000 people. As of 2018, that ratio had improved to one doctor per 2,000 people.
  6. In June 2018, the U.N. awarded Thailand with the UN Public Service Award for its initiative to provide cervical cancer treatment to women in rural areas.
  7. Another measure taken to prevent cervical cancer in Thailand is the provision of the HPV vaccine to girls aged between 10 and 13 years. Thailand is one of four countries in the South-East Asia region to have introduced the HPV vaccine nationally.

It is quite possible that Thailand will meet the WHO’s request to eliminate cervical cancer by 2030. The country is a good example to other low and middle-income countries on how they can deal with the disease.

– Sophia Wanyonyi
Photo: Pixabay

HPV Vaccine in the Middle EastGlobalization opens up channels to foreign cultural trends and facilitate the free exchange of ideas between populations of different countries. Youth in more religiously and culturally conservative regions of the world are particularly influenced by foreign representations of sexual intercourse in pop culture. Tackling problems surrounding the HPV vaccine in the Middle East and North Africa is becoming more of an issue as young people are beginning to experiment more with sex but without the preventive measures taken by other countries to confront sexually transmitted diseases and the long-term consequences of exposure.

Regional Barriers to Preventive Measures

Since many people in the Middle East and North Africa associate the immunization of adolescents with STI-preventing vaccines with the presumption that adolescents are seeking sexual intercourse, religiously strict societies of this region fail to implement preventive sexual health measures such as HPV vaccinations and cervical cancer screenings. Common understanding suggests that these societies view the HPV vaccine as an infringement on long-standing cultural and religious practices and a foreign intrusion on regional values. However, this perception is largely shaped by key religious leaders and politicians who regulate public discourse and are viewed as possessing the authority to distinguish between what is morally right and wrong. In fact, contributors working on behalf of the Eastern Mediterranean Health Journal have discovered that most families in the Middle East and North Africa display an acceptance of STI-preventing vaccines and educative initiatives promoting sexual health.

Public View on the HPV Vaccine in the Middle East and North Africa

A study published by WHO in 2017 examined 18 studies pulled from the PubMed and Embase databases dated between January 2010 and April 2017 to ascertain the prevalence of the HPV vaccine in the countries composing the Arab World. The selected studies interviewed various groups and subgroups of national populations, including adolescent men and women, young men and women, women of various age groups, healthcare professionals and parents. Among a variety of questions probed were knowledge of the existence of an HPV vaccine and awareness of the causal link between HPV and cervical cancer. The question limited to this report address general acceptance of the HPV vaccine in the Middle East and North Africa.

The results were promising. Considering the religious composition of the Arab World, the non-secular identities of political bodies in Arab countries and the influence of religion on policymaking, 99 percent of Egyptian women, 91.3 percent of Bahraini women and 89.9 percent of Saudi women were accepting of the HPV vaccine. Rates of acceptability among women tended to be high in most Arab countries, although the lowest incidence was recorded by a study of Emirati women which showed an acceptability rate of 46 percent. The average acceptability rate for university men in the United Arab Emirates was 46 percent and a 2015 study in Morocco showed that 76.8 percent of mothers and 68.9 percent of fathers approved of immunizing their children with the HPV vaccine.

Promoting the HPV vaccine in the Middle East and North Africa

The national health organizations of many countries in the region are promoting an open discourse about sexual health and advocating for the institutionalization of vaccinations in public facilities such as schools. Cervical cancer remains among the top ten leading causes of death among women in Arab countries. Meanwhile, Israel possesses one of the lowest rates in the world. This could be due to the institutionalized vaccination system in the Israeli school system. However, Baruch Velan, a vaccination compliance researcher at the Gertner Institute for Health Policy and Epidemiology in Israel, cites that the HPV vaccine compliance rate is higher in the Arab population than in the Jewish population in Israel. Why Israel has such low rates of cervical cancer, especially compared to other countries in the region, is unknown.

The changing views toward the HPV vaccine in the Middle East and North Africa shows that there is hope to increase vaccinations and decrease rates of cervical in the region.

– Grayson Cox
Photo: Flickr

All You Need to Know About HPV in the Developing World
Human papillomaviruses (HPV) are DNA viruses that infect skin or mucosal cells. Depending on the severity of the infection, HPV can lead to either cervical cancer and other head and neck cancers or low-grade cervical tissue changes and genital warts. Virtually all cervical cancer cases result from a sexually transmitted infection with HPV.

Cervical Cancer and HPV in the Developing World

Globally, cervical cancer is known as the second most common cancer among women, with about 500,000 new cases being diagnosed annually. Of the total deaths that occur due to cervical cancer each year, more than 80 percent are concentrated in developing countries.

Immunization coupled with regular screenings and consistent treatments are the best strategies for reducing the burden of cervical cancer and HPV in the developing world. In resource-poor countries that lack adequate access to cancer screenings and treatment services, it is even more essential that younger girls be immunized before they are sexually active and are exposed to HPV.

The HPV Vaccine

The HPV vaccine protects against the strains that cause up to 90 percent of cervical cancer cases. It is typically available in most routine immunization programs of high-income countries. Historically, the major barriers to reducing the burden of cervical cancer and HPV in the developing world are due to the high costs of the HPV vaccines and the difficulty of reaching adolescent girls.

The GAVI Alliance–formally known as the Global Alliance for Vaccines and Immunization–is a partnership of national governments, the World Health Organization (WHO), the World Bank Group, the Bill and Melinda Gates Foundation, the vaccine industry and many public health institutions. GAVI provides technical and financial support for vaccines in countries that have a gross national income of less than $1,000 per capita and other poverty-stricken countries including China, India and Indonesia.

Thanks to the efforts of GAVI, the HPV vaccine is at a record low price and the poorest countries are able to access it for as little as $4.50 per dose. Additionally, the WHO decided to change the recommended dosage of the HPV vaccine from three to two doses, which helped facilitate the country rollout of the vaccine as well as significantly reducing costs.

The first HPV vaccine demonstration program took place in Kenya in 2013, and since then, 1,000,000 girls have been vaccinated. By the end of 2016, GAVI had initiated HPV vaccine demonstration programs in 23 countries, which is the first step toward introducing the vaccine to national immunization programs. So far, Honduras, Rwanda and Uganda have introduced the HPV vaccine into their national immunization programs.

Potential Roadblocks in the Push for the HPV Vaccine

Unfortunately, the transition from the demonstration programs to national introductions is taking longer than expected for some countries. Consequently, GAVI has developed a new approach to HPV vaccine support, which draws from the valuable lessons learned from previous demonstration programs.

Some of these lessons include:

  1. The fact that school-based delivery works very well when administering the vaccine to young girls. It is more cost effective to integrate HPV immunization efforts into routine immunizations at existing health clinics and schools.
  2. When promoting HPV vaccination programs and cervical cancer prevention, the facilitation of effective and factual communication within the community is particularly critical.
  3. GAVI has made tremendous progress in reducing the prevalence of HPV in the developing world through its vaccination initiatives. Eight GAVI-supported countries have integrated the HPV vaccine into their national vaccination programs and 30 countries have started a demonstration program.

However, despite the strong signs of interest from GAVI-eligible countries and the rapid and effective integration of the HPV vaccine, GAVI’s original goal of immunizing 40,000,000 girls by 2020 may be at risk due to supply constraints.

GAVI chief executive Dr. Seth Berkley stated, “Scaling up cervical cancer prevention and control strategies should not be delayed, as we have the tools to achieve this goal. With the right commitment from vaccine manufacturers as well as political support, strategic partnerships and investments, this particular battle to improve women’s health can be won.”

Thus far, GAVI has helped low-income countries access the HPV vaccine at affordable and sustainable prices. Dr. Berkley is confident that the organization is capable of meeting its goal. GAVI is dedicated to ensuring that its progress is maintained and that millions of girls in the poorest of countries are protected from the perils of HPV and cervical cancer.

– Lolontika Hoque
Photo: Flickr

Cancer in Resource-Poor Countries
In 2012, 3.5 million women died from cancer. Women are diagnosed with cervical and breast cancer at a rate of about 2 million per year, and the diseases’ outcome can largely be predicted by geography. According to The Lancet, 62 percent of deaths resulting from breast cancer occurred in low- and middle-income countries. Similarly, 87 percent of deaths due to cervical cancer occurred in resource-poor countries. Clearly, fighting cancer in resource-poor countries can be difficult.

These trends are even more concerning given that the number of cancer-related deaths among women is expected to increase to 5.5 million by 2030. Over this same time period, the number of women diagnosed with breast cancer is expected to nearly double, and the number of women diagnosed with cervical cancer is expected to increase by 25 percent.

Most global health efforts targeted toward women focus on sexual and reproductive health. However, non-communicable diseases like cancer, cardiovascular disease, respiratory disease, diabetes, dementia, depression and musculoskeletal disorders constitute the greatest threats to women’s health. Indeed, breast cancer and cervical cancer result in three times as many deaths as childbirth and pregnancy complications do.

Further, the global economic burden of cancer is sizable ($286 billion in 2009), primarily because it keeps people out of the workforce and can lead to premature death. Addressing the burden of cancer on women’s health could lead to increased female participation in activities that benefit countries’ economies.

Even in more developed countries, cancer screenings and appropriate treatments are not equally available to all groups. Women belonging to ethnic and cultural minorities, in particular, may not have access to essential health care.

However, cancer screening and treatment is not as costly as is often assumed. As little as $1.72 per person could provide essential medical interventions to diagnose and treat cancer effectively. This amount is about 3 percent of current health care spending in resource-poor countries.

Mammograms for breast cancer screening and radiography for cancer treatment are not often available in low- and middle-income countries. A series of articles from The Lancet recommended increasing the availability of the HPV vaccine for girls and providing cost-effective screening procedures like clinical breast examinations and cervical cancer screenings through visual inspection with acetic acid.

The articles also called for mastectomy and tamoxifen treatments to be made available to people fighting cancer in resource-poor countries by 2030. The Lancet cited Mexico and Thailand as examples of countries where universal health care coverage has improved the diagnosis, treatment and outcome of cancer in women.

Madeline Reding

Photo: Flickr

Jhpiego is an international nonprofit health organization and an affiliate of Johns Hopkins University. Jhpiego’s programs are primarily centered on the prevention of unnecessary deaths of women and children in developing countries. The organization works on the front lines in urban slums and rural settings to design accessible and affordable healthcare solutions. Jhpiego is currently active in 40 countries, concentrated in Africa, Asia, Latin America and the Caribbean.

The organization works with healthcare professionals, influential community members and government leaders to deliver quality healthcare for those in need. It also focuses on developing sustainable strategies for communities in developing countries to manage their own well-being. Jhpiego trains local healthcare workers, improves the quality of community health systems and makes delivery of care, services or products more efficient and dependable. It focuses on developing technologies and solutions that can be used both in hospitals or in the home. The organization’s provision of affordable healthcare for women and families ensures of level of care previously unattainable by many of the recipients.

Jhpiego began as an acronym for the Johns Hopkins Program for International Education in Gynecology and Obstetrics, yet the organization has now expanded its efforts to tackle issues such as the prevention and treatment of HIV/AIDS, infection, malaria, tuberculosis and cervical cancer. Jhpiego’s science division also researches innovative technology that has the potential to help poor and vulnerable communities. The ultimate goal is sustainability—giving poor communities the tools and education they need to build a foundation of good health and continue the cycle without outside assistance or aid.

As an affiliate of a prestigious university, Jhpiego has the advantage of being well-connected. In June 2014, the United States Agency for International Development (USAID) awarded $500 million to Jhpiego to fund a program to alleviate maternal and child mortality. Jhpiego is currently using the funds to spearhead a five-year program centered around preventing child deaths due to treatable causes like diarrhea and pneumonia. By working in conjunction with other partners and nonprofits, Jhpiego seeks to create a network of aid to mothers and children in need.

Jhpiego will use the funds to provide cost-effective vaccines and antibiotics to the 24 countries with the highest numbers of child mortality. Jhpiego will also provide other medical equipment, train community medical providers and reach out to women in slums and rural areas. The USAID funds will be used to research prevention and treatments for the leading causes of death for mothers and children. Among mothers, the leading causes of mortality include uncontrolled bleeding after birth, infections and high blood pressure during pregnancy. Among newborns, asphyxia and low birth rate. And among young children, pneumonia, malaria and diarrhea.

Since 1990, the global child mortality rate has nearly been halved. Yet Jhpiego’s efforts instill hope that the number can be further lowered. Jhpiego works with NGOs and government policymakers alike to increase accessibility to quality health services. By focusing on sustainable, cost-effective health solutions, Jhpiego can help provide care for underrepresented, vulnerable populations.

– Mari LeGagnoux 

Sources: Baltimore Sun, Jhpiego
Photo: Jhpiego

CHICAGO – Though most people would agree on vinegar’s extraordinary versatility in the kitchen, few would suspect that the liquid could have a powerful influence in the medical field through cervical cancer screening.

New research presented in an early June cancer conference in Chicago has revealed that testing for cancerous cells in the cervix with vinegar swabs could be the key to slashing cervical cancer-related deaths in under-developed countries.

The new screening method is called VIA (visual inspection with acetic acid) and uses sterilized vinegar made from combining acetic acid with water. Since its introduction in 2001, the low-tech visual exam has cut the cervical cancer rate in Indian women who were screened by 31 percent compared to women who did not undergo the cervical cancer screening.

Pap smears and tests that help to find and prevent HPV in women are only successful in reducing death rates in the countries that can afford them. In developing countries with little access to both preventative and treatment-related modern medical technology, a study has shown that these new low-tech cervix tests that use vinegar could save thousands of lives each year.

Whereas a Pap test would normally cost around $15 per test, the vinegar screening only costs $1. Specifically, the tests have proven beneficial in the slums of India, where cervical cancer is the leading cause of cancer-related death amongst women.

How does it work? Swabbing the cervix with vinegar causes abnormal cells in the cervix to temporarily change color while healthy tissues remains colorless, thus making cancer cells easily identifiable by medical analysts. Locals can perform the vinegar tests with merely two weeks of training and without expensive lab equipment.

Researchers have found that widespread implementation of the new vinegar screenings could prevent nearly 75,000 deaths in resource-deprived countries around the world. If the studies prove conclusive and the low-tech vinegar-based cancer screening tests become a worldwide phenomenon, vinegar may begin to replace diamonds as a girl’s best friend.

– Alexandra Bruschi

Source: The Wall Street Journal, The Daily Mail
Photo: Global Giving

Every year, approximately 275,000 women lose their lives to cervical cancer. The vast majority of these women live in developing countries where it is difficult to access the necessary healthcare, and where the ability to screen, diagnose and treat the life-threatening cancer is rarely available. However, the fight against cervical cancer in developing countries received an unprecedented boost when the GAVI Alliance announced recently that it had guaranteed a record low price of $4.50 per dose for the human papillomavirus (HPV) vaccines.

For the first time, the GAVI Alliance will make the vaccination available to girls of a school age on a widespread scale, and at an affordable price. The GAVI Alliance has already begun their vaccination program in Kenya where cervical cancer is responsible for the deaths of more Kenyan women than any other cancer. In the past, most of the HPV vaccine programs have only been available in richer countries despite the fact that the need for these programs has always existed in developing countries. Dr. Seth Berkley, CEO of the GAVI Alliance, said that through their partnership with WHO and UNICEF, their support for HPV vaccines is “bridging the gap between rich and poor countries, enabling HPV vaccines to reach girls no matter where they live.”

The vaccine is distributed in three doses, and since Kenya has high enrollment rates among girls, schools will become the main centers for the HPV vaccines. With the support of community health workers, the treatment will also be available to girls who are unable to attend school, and who are often at higher risk of contracting the disease.

Seven other sub-Saharan countries will also receive support from the GAVI Alliance in the near future; Ghana, Lao PDR, Madagascar, Malawi, Niger, Sierra Leone and Tanzania. The GAVI Alliance estimates that by 2020, it will have immunized more than 30 million girls in 40 countries. In these countries, where access to diagnosis and treatment is seldom available, providing a preventative vaccine is the clearly preferred option. This news provides hope to millions of girls and women in developing countries who remain at risk of contracting cervical cancer.

– Chloe Isacke
Source: GAVI Alliance,Impatient Optimists
Photo: WUSC