Download file, English (1 MB PDF) - RHO

Questions and Answers
1. What does WHO recommend specifically for Africa in regard to HPV vaccination?
Dr. Wang replied to this question by saying that the WHO position paper on vaccines against HPV is for
global use and does not make recommendations for specific regions or countries. This is different from
papers on, for example, measles, where the WHO position is a blanket recommendation. As the HPV
vaccine position paper states, each country must look at its priorities and whether vaccination programs
will be sustainable.
2. Are men involved in the screening projects in Zambia?
Dr. Parham commented that the teams spend considerable time talking with men about the fact that
HPV is a sexually transmitted disease, and about how important it is for women to be screened.
3. How will screening change in future years, after many girls have been vaccinated?
Dr. Jeronimo commented that if the incidence of HPV 16 and 18 (the major types current vaccines
protect against) decrease in the population, precancerous lesions may not be as easy to detect with VIA
or colposcopy. However, HPV DNA testing is very good for finding all oncogenic HPV types.
4. What is the recommended age for HPV DNA testing?
According to Dr. Jeronimo, women should be aged 30 years and older for DNA testing. Most women
(and men) become infected with HPV shortly after initiating sexual activity, and most are able to clear
the infections with normal immune responses. Precancerous lesions and cervical cancer typically
develop only after persistent infection, so testing women aged 30 and older is the most efficient way to
screen.
5. Can HPV DNA tests be used in remote areas?
The low-cost careHPV Test does not require running water. It does need electricity, but this can be
provided by a battery.
6. How do women view self-sampling for the HPV DNA test?
Dr. Jeronimo noted that the START-UP study teams expected that women would not respond positively
to this approach, but they were surprised to find that the opposite was true. In the Nicaragua and India
studies, they are finding that 80 to 85 percent of women prefer self-sampling to provider sampling.
7. How can countries train physicians to provide cervical cancer screening and treatment programs?
A participant pointed out that what is needed is training for nurses and midwives in VIA and
cryotherapy—physicians are not needed for this.
Dr. Parham of the Zambia team stated that we need physician training for treatment rather than
screening. For early stage invasive cervical cancer, we need skilled surgeons and radiation treatment.
Many surgeons have not been trained for this surgery.
Report of an African Regional Meeting on Cervical Cancer: September 2010 43