WHO Global Strategies in Cervical Cancer Prevention and Control
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1 WHO Global Strategies in Cervical Cancer Prevention and Control Dr. JM. DANGOU WHO-AFRO 1 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
2 Cervical Cancer burden Age-standardised rates < cases deaths SOURCE: GLOBOCAN 2012, IARC 2 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
3 Cervical Cancer burden HPV = Infectious cause of cancers - Total attributable: 0.56 million cases/year Bridging the gap: WHO s comprehensive approach / life course WHO Guidelines and Policies: making choices The way forward: health system building for CxCa control 3 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
4 WHO Guidelines for Cervical Cancer Prevention and Control The first comprehensive clinical guide from WHO on CxCa control Translated into the six official WHO languages Content WHO Recommendations Background Anatomy & CxCa natural history HPR Screening for CxCa Diagnosis & management of precancers Management of invasive CxCa Palliative care C4-GEP 4 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
5 Comprehensive Cervical Cancer Prevention & Control 5 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
6 Building Blocks for Cervical Cancer Control Information Leadership Financing Medical products, vaccines & technology Services Health Workforce 6 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
7 Guideline introduction Scalingup Situation Analysis Introduction and Adaptation (country level) Stakeholders and trainers Key interventions Monitoring and evaluation Partners Implementation plan Partners Partners Introduction and orientation (sub-regional level) National policies Practices Epidemiological data Resources Partners Partners 7 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
8 So, 2014: the new C4-GEP Chapter 1: Epi, Nat Hist, AnaPath Chapter 2*: Programmatic issues Chapter 3: Heath Education Chapter 4*: HPV Vaccination Chapter 5*: Screen and TTT strategies of pre-cancer Chapter 6: Diagnosis and TTT Chapter 7 : Palliative care 8 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
9 WHO Position Paper on HPV Vaccine (2009) HPV vaccination should be introduced into national immunization programmes where prevention of cervical cancer and other HPV-related diseases is a public health priority and where vaccine introduction is programmatically feasible and financially sustainable. World Health Organization. Human papillomavirus vaccines. WHO position paper. Wkly Epidemiol Rec 2009; 84: Countries should prioritize achieving high coverage in the primary target population of 9 to 13 year old girls. 9 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
10 WHO Position Paper on HPV Vaccine (2009) Other considerations for HPV vaccination: Introduce as part of a coordinated strategy to prevent CxCa and other HPV-related disease. Prioritize populations who are likely to have less access to CxCa screening later in life. Seek opportunities to link vaccine delivery to other health services and programmes targeting young people. Do not divert resources from effective CxCa screening programmes. 10 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
11 HPV vaccination: strengthening health system HPV vaccination raise issues of cost and financing and programme delivery to adolescents But it may strengthen or support adolescent immunization programmes, through schools or other delivery systems, according to country-specific needs and socio-cultural context It may also link immunization with other public health interventions for adolescent (sexual health and other health interventions) It could increase screening rate among mothers 11 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
12 Consensus on HPV vaccine coverage and impact monitoring - November 2009 meeting HPV vaccine coverage monitoring by dose and by year of age is necessary HPV vaccine impact monitoring is complex and is not a precondition for HPV vaccine introduction Establishing or improving CxCa reporting to cancer registries is advisable for all countries to monitor impact of vaccine and CxCa screening programs Article on meeting highlights available at Complete meeting report available at 12 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
13 13 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
14 14 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
15 WHO Guidance on Comprehensive Cervical Cancer Control In 2012 WHO Guidance Note on Comprehensive approach to CxCa prevention and control Interdisciplinary stakeholders and solid in-country coordination needed by MoH Ministry of health: Immunization, sexual and reproductive health, adolescent health, cancer control, and HIV prevention partners Ministry of education: school health Women's groups, Community based group to reach girl out of school External partners 15 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
16 Comprehensive approach: Programmatic interventions over the life course to prevent HPV infection and cervical cancer PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION Girls 9-13 years HPV vaccination From 10 years old and onward Health education and services, for example: Sexual health education tailored to the age group Providing contraceptive counseling and services including condoms Prevent tobacco use and support cessation* Women > 30 years of age Screening and treatment screen and treat with low cost technology VIA followed by cryotherapy HPV testing for high risk HPV types (e.g. types 16, 18 and others) All women as needed Treatment of invasive cancer at any age Ablative surgery Radiotherapy Chemotherapy 16 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
17 Cervical Cancer Control in the Global NCD Action Plan UN Political Declaration on NCDs result of a promising debate Problem: NCD burden and its determinants (social, risk factors, weak health systems ) Solutions: Guiding principles: whole of government approach, multiple stakeholders, cost- effectiveness of interventions. Risk reduction strategies: Screening and Vaccination Health system strengthening 17 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
18 WHO's global NCD control Framework Surveillance Mapping the epidemic of NCDs Prevention Reducing the level of exposure to risk factors Management Strengthen health care for people with NCDs 18 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
19 World Health Assembly 2013: NCD Resolution 19 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
20 Cervical cancer indicators Performance indicators Screening rate of the target population (women aged years): Percentage of women aged years who have been screened for the first time with VIA in the previous 12-month period. Positivity rate: Percentage of screened women aged years with a positive VIA test result in the previous 12-month period. Treatment rate: Percentage of VIA-positive women receiving treatment in the previous 12-month period. Result indicator Coverage rate indicator: Percentage of women aged years who have been screened with VIA or another screening test at least once between the ages of 30 and 49 years. Impact indicator Cervical cancer age-specific incidence. 20 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
21 One WHO Work Plan What is it? Method of work for WHO to implement the actions for the WHO Secretariat included in the WHO Global NCD Action Plan in a coordinated manner, including: Across the three levels of WHO (Country Offices, Regional Offices, Headquarters) Across the WHO Categories included in the WHO Programme Budget (e.g. communicable diseases, maternal health, emergencies) 21 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
22 UN Interagency Taskforce on NCDs TORs Enhance and coordinate technical support Facilitate information exchange about plans, strategies, programmes and activities Facilitate information exchange about available resources to support national efforts Strengthen advocacy Ensure that key interventions are jointly addressed Strengthen international cooperation 22 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
23 UN Interagency Taskforce on NCDs 23 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
24 UN General Assembly NCD Review 2014 Possible elements for an outcome document: What we hear from Member States Reducing cervical cancer mortality Increase Cervical cancer screening coverage Develop national plans. Reduce exposure to risk factors: HPV Enable health systems to respond: PHC > secondary > tertiary (radiotherapy surgery) Measure results: cancer registries 24 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
25 Companion guidelines to implement recommendations 25 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
26 26 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
27 Strengthening Cervical Cancer Prevention Programme Operational framework Palliative care Community level Awareness, Communication PHC level VIA VIA VIA VIA... Secondary level VIA and cryotherapy Training Tertiary level Treatment Monitoring and evaluation 27 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
28 Strengthening Cervical Cancer Prevention Programme New algorithms Palliative care Community level Awareness, Communication PHC level HPV HPV HPV HPV... Secondary level Cyto/Colpo and biopsies or VIA and cryotherapy Training Tertiary level Treatment Monitoring and evaluation 28 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
29 WHO guidelines: Use of cryotherapy for cervical intraepithelial neoplasia Available 2011 Recommendations Use of cryotherapy for prevention of CIN Lesion size Lesions extending into the endocervical canal Cryotherapy technique and procedure Providers Use of cryotherapy during pregnancy Retreatment of CIN lesions with cryotherapy Education 29 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
30 Technical specifications for cryotherapy equipment 30 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
31 QA/QC for VIA-cryotherapy based programmes 31 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
32 WHO Cervical Cancer Prevention and Control Costing Tool Help plan and select affordable strategies, the C4P Tool allows a country to cost HPV vaccine introduction under different scenarios scaling up of CxCa screening services. Developed to assist Tanzania's national planning developed into a generic tool. Outputs used for cost-effectiveness analysis, budgeting, and resource mobilization C4P Tool being incorporated into the UN One Health costing tool to allow cross-health sector planning. 32 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention Raymond Hutubessy, WHO IVB Geneva, Switzerland hutubessyr@who.int Tool including user guide soon available on WHO NUVI HPV website
33 Conclusion By developing and supporting implementation of guidance documents, WHO intends to overcoming the transfer and application of knowledge gap To take evidence into practice at all levels 33 Regional Conference on New Opportunities and Innovations in Cervical Cancer prevention
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