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Nationwide Interventions for Cervical Cancer in the Philippines » Women's Courage

Nationwide Interventions for Cervical Cancer in the Philippines

February 28th, 2013 by kenrique Leave a reply »

My past few blog posts have focused on community interventions to improve women’s reproductive and maternal health in the Philippines. This week, I want to discuss examples of an intervention that combines the efforts of both the public and private sphere – the Department of Health (DOH) and Merke Sharp & Dohme Philippines (MDS) – to improve women’s reproductive health nationwide. These sectors formed a partnership program, the National Cervical Cancer Prevention and Control Program, which offers free nationwide cervical cancer-screening for women aged 25 to 49 years old.[i]

Background on Cervical Cancer in the Philippines

            As the second most prevalent type of cancer in women (after breast cancer) in the Philippines, cervical cancer screening is vital to improving women’s reproductive health.[ii] In 2010, the prevalence rate for cervical cancer was 11.7% for every 100,000 women, or about 12 Filipino women died from cervical cancer per day.iii Cervical cancer rates have not changed since 1980, and the survival rate is 51.7%.ii

There are several problems with cervical cancer screening in the Philippines. One is the timing of cervical cancer diagnosis; about 66% of cervical cancer cases are diagnosed at an advanced stage, and mortality due to cervical cancer is high because of inadequate radiotherapy facilities.ii When screening does occur, it is often inadequate and inefficient in reaching the majority of the population. As I have mentioned before, the geography 7,100 islands that comprise the nation make it difficult to screen for cervical cancer in underserved, isolated communities. Thus, it is vital that the government and private sector cooperate to hold national cervical cancer screening programs, particularly with a focus on underserved communities.

Government and Private Sector Working Together

            The nationwide screening program facilitated by the DOH and MDS has occurred every May for five years. This national screening initiative was launched in order to reach out to more Filipino women in May, in honor of Cervical Cancer Awareness Month.i The screenings are typically offered to the public for free in 58 DOH hospitals around the country.

The National Cervical Cancer Prevention and Control Program consists of a three-pronged prevention approachi:

1. Primary prevention – Promotion of a healthy lifestyle and avoidance of risky sexual behavior

2. Secondary prevention – immediate screening for pre-cancerous lesions and other abnormalities and diagnosis

3. Tertiary prevention – Immediate treatment, when possible, to prevent the development of invasive cancer from precancerous lesions

For this partnership prevention program, the Philippines recently received the Gold Standard Award for Public-Private Partnership (PPP) from the Public Affairs Asia Network.[iii] The award recognized this partnership for its program achievements, including establishing a national symposium on cervical cancer prevention and control. Since the establishment of the partnership, more than 30,000 women have been screened for cervical cancer.iii Another positive aspect of this program is increased public awareness, which has pushed the agenda and support from both the public and private sectors to create a national policy focused on cervical cancer prevention, early diagnosis, and treatment.iii This program seems like a positive example of how government and private companies can work together to influence national policy and the reproductive health of women throughout the country.

Filling in the Gaps – Cervical Cancer Screening and Treatment in Underserved Filipino Communities

            One potential issue with the National Cervical Cancer Prevention and Control Program is the lack of services in isolated, rural communities, as most of the screenings have taken place in hospitals affiliated with the Department of Health. In order to address the lack of services and resources in rural communities, Family Planning Organization of the Philippines (FPOP), a member of the International Planned Parenthood Federation, aims to provide cervical cancer screenings to 120,000 poor and underserved women in rural communities. [iv]

To address the lack of resources in these communities, FPOP uses the Single Visit Approach, which involves screening through Visual Inspection with vinegar, which involves applying 3-5% acetic acid to the cervix and inspecting for precancerous lesions.iv If this test is positive for abnormalities, treatment can be administered in the form of Cryotherapy, which involves freezing the cervix with compressed carbon dioxide or nitrous oxide gas in order to destroy precancerous lesions.iv

As part of the Single Visit Approach, women are offered counseling, screening, complete pelvic examination, and discussion of results.iv The Single Visit Approach provides a practical method of screening for cervical cancer in under resourced communities because screening and treatment can take place in one visit with a health care provider, so it is both more affordable for low-income women and more efficient for health care providers.

 

These two nation-wide approaches to cervical cancer screening and prevention seem like positive steps to decreasing cervical cancer rates in the Philippines. In order to improve the reproductive health of Filipina women nationwide, I think it is especially important for national and community programs to work together to not only target urban areas where cervical cancer rates are highest, but also to reach out to poor and under resourced communities.

 


[i] Tiu, Olivia. DOH promotes one-stop cervical cancer screening. Philippine Information Agency. http://www.pia.gov.ph/news/index.php?article=1141336012279

[ii] Germar MJV. Interventions targeted at women to encourage the uptake of cervical screening: RHL commentary (last revised: 7 October 2004). The WHO Reproductive Health Library; Geneva: World Health Organization.

http://apps.who.int/rhl/archives/mjgcom/en/index.html

[iii]PPP on Cervical Cancer advocacy wins Public Affairs Asia Award. The Manila Times Online. http://www.manilatimes.net/index.php/127-healthnews/40129-ppp-on-cervical-cancer-advocacy-wins-public-affairs-asia-award

[iv]Cervical Cancer Screening and Treatment of Women in Far flung Communities. Family Planning Organization of the Philippines. http://www.fpop1969.org/howtohelp/ccscreening.html

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5 comments

  1. Carmen says:

    Thanks for blogging about such a great intervention! In a country with escalating rates of cervical cancer diagnosis, I am glad to see the government and private sector working together on interventions at the level of secondary prevention. From screening and getting the inexpensive acetic acid test to cryotherapy treatment in one appointment, the intervention eliminates several of the barriers women have to receiving care. A majority of cervical cancer cases occur in underserved areas where people may not have the protective measures and education to understand how to protect themselves from the disease. It is important to supplement the simple technology with education and tools for how to prevent the disease in the first place.

  2. Sam says:

    Its always frustrating to hear about societies that have to deal with a big problem when, that problem, could be so easily reduced by a simple technology. So, when we have examples of people who are working to solve issues like cervical cancer, its really fun to hear. thanks for sharing!

  3. louiselu says:

    It is certainly very interesting that the public health community has decided to approach the issue of reducing cervical cancer mortality from a primary prevention standpoint to a secondary prevention one. Screening women for pre-cancerous lesions with the acetic acid test and having the capability to remove those lesions in a single-visit approach seems like a fantastic and ideal solution — an example of a very successful “low-tech” intervention. Thanks for exploring this topic in detail, Kathryn!

  4. Jessie says:

    This seems like an incredibly important project given the high prevalence of cervical cancer in the Philippines, and the partnership between the public and private sector promises to make this a sustainable program. However, one important aspect of effective screening programs is to have adequate and effective treatment options available if the tests come back positive. You mentioned inadequate access to radiotherapy treatment options. It seems that a screening program will not reach its full potential and will be a waste of resources if sufficient treatment is not available. Thus, though this is an important part of a program to reduce the impact of cervical cancer on women in the Philippines, more of an investment must also be made toward increasing the availability of treatment options, addressing the tertiary preventative needs of these women. Perhaps tertiary prevention will be the next logical step to address once the primary and secondary preventative measures are in place.

  5. Meghan says:

    With cervical cancer being often so simple to detect, and possible to cure if caught in a decent time frame, this type of intervention is so crucial to improving women’s health. It’s great that the program you mentioned doesn’t just provide screening but provides a three pronged approach to reach different levels of prevention and treatment. Not only that but also the expanded outreach to more rural communities usually ignored in the intervention sphere represents a huge step forward in improving women’s health in the Philippines. Thanks for the great post!

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