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With these new tools in hand, we are more hopeful than ever that cervical cancer cases will soon decrease, especially in our African countries. I congratulate our conference participants on a successful meeting and hope that everyone makes great progress! World Health Organization Uganda Country Office Dr. Joachim Saweka, WHO Country Representative, Uganda The latest statistics from WHO tell a harsh story: in Uganda, cervical cancer has by far the highest estimated incidence and mortality of any cancer in women: 48 per 100,000 and 35 per 100,000, respectively. In fact, this is the highest mortality for any cancer for men or women in this country. HPV vaccines have great potential to prevent deaths, but there are challenges to delivering the vaccines to the target population, since this group is older than the population normally targeted for routine childhood immunizations. In addition to introducing vaccinations, countries must increase access of women to screening and early treatment. Cervical cancer prevention includes the areas of reproductive and sexual health, cancer, and immunization, so collaboration among these departments is essential to ensure efficient and effective programs. Finally, the HPV vaccines must be made affordable to developing countries, where they can have the most impact. Together, African countries can negotiate prices that will allow us to establish sustainable vaccination programs. Association of Obstetricians and Gynaecologists of Uganda Dr. Daniel Murokora, President, AOGU Clinicians play a pivotal role in cervical cancer prevention, not only in their care of patients but also in their interactions with colleagues and community leaders. We need to further encourage the training of nurses, midwives, and other health workers—as well as doctors—in visual inspection as a screening method, because the demand for screening and treatment of precancerous lesions is far beyond the available capacity in our countries. Our ability to provide radiotherapy and other tertiary care is also severely limited, and we need to lobby for improvements in these programs as well as in palliative care, especially until the day when HPV vaccinations begin having a measurable effect on the number of cases of invasive cancer. Our goals should include encouraging comprehensive cervical cancer prevention, such as advising our adult women patients to take their daughters or granddaughters for HPV vaccination when available. A goal for all the African countries attending this meeting is to put in place official strategic plans for comprehensive cervical cancer prevention. In Uganda we now have the Strategic Plan for Cervical Cancer Prevention and Control, but it is not funded directly by government. Funding constraints at all levels are a major problem, so clinicians must work with community leaders to lobby for this support. Only when all stakeholders assent to the overwhelming need for a strategic plan and the funds to implement it will we see a significant decrease in the numbers of women dying from this preventable disease. Report of an African Regional Meeting on Cervical Cancer: September 2010 5
Abbreviations ACCP AFRO AOGU CDP EPI HPV IARC IEC LEEP MOH MOHSW NGO PAHO PATH START-UP UICC UN UNEPI UWHI VIA VILI WHO Alliance for Cervical Cancer Prevention Regional Office for Africa (WHO) Association of Obstetricians and Gynaecologists of Uganda Child Days Plus Expanded Programme on Immunization human papillomavirus International Agency for Research on Cancer information, education, and communication loop electrosurgical excision procedure Ministry of Health Ministry of Health and Social Welfare nongovernmental organization Pan American Health Organization Program for Appropriate Technology in Health Screening Technologies to Advance Rapid Testing—Utility and Program Planning Union for International Cancer Control United Nations Uganda National Expanded Programme on Immunization Uganda Women’s Health Initiative visual inspection with acetic acid visual inspection with Lugol’s iodine World Health Organization Report of an African Regional Meeting on Cervical Cancer: September 2010 6
Page 1 and 2: Report of an African Regional Meeti
Page 3 and 4: Table of Contents Foreword ........
Page 5: Foreword Ministry of Health of Ugan
Page 9 and 10: Several other countries reported va
Page 11 and 12: Expected Results • Deepened knowl
Page 13 and 14: Overview of Cervical Cancer Prevent
Page 15 and 16: WHO recommendations for care for wo
Page 17 and 18: Uganda HPV Vaccine Demonstration Pr
Page 19 and 20: HPV Vaccine Demonstration Project G
Page 21 and 22: This approach also presented a numb
Page 23 and 24: The coverage survey also asked pare
Page 25 and 26: Dr. Murokora and the research team
Page 27 and 28: Questions and Answers 1. What were
Page 29 and 30: Country Experiences in Cervical Can
Page 31 and 32: e used for advocacy and communicati
Page 33 and 34: Other initiatives include the follo
Page 35 and 36: • Coordination of services - Stre
Page 37 and 38: Encouraging Results from Expanded S
Page 39 and 40: Questions and Answers 1. Why has Ug
Page 41 and 42: strategies should be compatible wit
Page 43 and 44: The Unseen Forces Guiding the Cervi
Page 45 and 46: Questions and Answers A question ab
Page 47 and 48: Essential materials have been colla
Page 49 and 50: Challenges remain for keeping cervi
Page 51 and 52: Working Groups on Cervical Cancer P
Page 53 and 54: Group 2: Lesotho, Malawi, and Zambi
Page 55 and 56: services. However, the infrastructu
Page 57 and 58:
Next Steps Dr. Jean-Marie Dangou Me
Page 59 and 60:
Cervical Cancer Prevention Resource
Page 61 and 62:
Annex 1: Final Agenda Improved cerv
Page 63 and 64:
Agenda Day 1, September 14 8:00 PAR
Page 65 and 66:
Agenda Day 2, September 15 8:30 REV
Page 67 and 68:
Annex 2: List of Participants Camer
Page 69 and 70:
Uganda (continued) Dr. Cecilia Banu
Page 71 and 72:
Uganda (continued) Dr. Lorna Muhirw
Page 73 and 74:
Uganda (continued) Dr. Rachel Seruy
Page 75 and 76:
Annex 3: Cervical Cancer Rates Cerv
Page 77 and 78:
Annex 4: Situation Analysis SITUATI
Page 79 and 80:
SECTION III CERVICAL CANCER PREVENT
Page 81 and 82:
4. TREATMENT AND PALLIATIVE CARE 4.
Page 83 and 84:
Annex 5: Prioritization Exercise PR
Page 85 and 86:
Annex 6: Country Priorities, Activi
Page 87 and 88:
Lesotho Priorities • Advocacy, ge
Page 89 and 90:
Rwanda Priorities • Mass sensitiz
Page 91 and 92:
Uganda Priorities • Training at v
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