This year, in recognition of World Cancer Day, CDC’s Division of Cancer Prevention and Control (DCPC) is raising awareness about the impact of cancer around the world and CDC’s efforts to reduce the global burden. DCPC’s global activities include cancer prevention and control projects in Colombia, Brazil, Bolivia, Trinidad and Tobago, Tanzania, Kenya, Zambia, Botswana, India, Thailand, and Vietnam.
Many of these global projects are focused on helping to reduce the burden of cancer in developing regions, where more than half of the annual 14 million new cancer cases and 8 million cancer deaths occur. Among women worldwide, cervical cancer is the fourth most common cancer and the fourth leading cause of cancer-related death, but in less developed regions, the burden is much higher.
Eighty-five percent of cervical cancer deaths occur in developing countries where cervical cancer screening programs are incomplete or nonexistent. Because most women with cervical cancer in developing countries are 50 years old or younger, cervical cancer is the largest cause of years of life lost due to cancer in the developing world.
Since 2012, I have been involved in CDC’s efforts to improve cervical cancer awareness and prevention services in Kenya, where cervical cancer is the most common cancer and the second leading cause of cancer-related deaths. Cervical cancer accounted for 20% of all cancers among women based on 2002 data from the Nairobi Cancer Registry. The percentage may be higher since population based data are not available for all of Kenya. High cervical cancer rates emphasize the growing need for effective prevention and treatment programs.
Cervical cancer prevention services exist in Kenya, but few women can access them. The human papillomavirus (HPV) vaccine helps prevent certain types of cervical cancer and is offered through a demonstration project in the Kitui district. Recently, the number of sites offering treatment for cervical cancer has increased to 300, in part through the support of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which has increased screening for women with HIV who are at greater risk for cervical cancer. However, access to screening services is still limited and only about 3% of women in Kenya between 18 and 69 years have been screened for cervical cancer.
To improve cervical cancer prevention in Kenya, the Ministry of Public Health and Sanitation and the Ministry of Medical Services released The National Cervical Cancer Prevention Program Strategic Plan (2012–2015). Its goals are to increase access to and the provision of high quality cervical cancer prevention and treatment services. Another goal is to increase awareness of cervical cancer prevention so that health personnel, other relevant government staff, community leaders and eligible women and their male partners understand the need for prevention services and support using available services (behavior change communication strategy). In preparation for the increased provision of low-cost cervical cancer screening and treatment services, there will be a growing need to assess community acceptability and increase community knowledge and awareness about the HPV vaccine and cervical cancer prevention.
Last year, the Kenya Medical Research Institute (KEMRI) and CDC worked together on a qualitative study to assess community knowledge and attitudes about cervical cancer, and anticipate potential barriers and facilitators to cervical cancer prevention and treatment services. As part of this study, focus groups and in-depth interviews were conducted with women, male partners, faith-based leaders, district chiefs, policy makers, doctors, nurses, community health workers, and journalists. Educational and messaging materials on cervical cancer prevention and treatment also were tested.
The results of this study will provide useful information on knowledge, awareness, and acceptability of cervical cancer prevention, early detection, diagnosis, and treatment that could inform service adherence, delivery, and implementation. Findings from key informants in the areas of health, media, and medicine will provide information on appropriate ways to communicate about cervical cancer screening and precancer treatment. Additionally, tested and adapted cervical cancer educational materials will be useful in community mobilization efforts and communication campaigns.
Working with KEMRI, I have noted the importance of continued community engagement, assessment, education, and communication in building a strong foundation for trusted cervical cancer prevention and treatment services. After witnessing firsthand the effectiveness and acceptance of simple messaging, CDC and KEMRI will continue to work with Kenya’s Ministry of Public Health and Sanitation, Ministry of Medical Services, and other partners to disseminate educational resources.