We were shocked to hear one of the dutch doctors international health and tropical medicine passed away during his work in Sierra Leone last week. Our condolences go out to his family and friends.
The most significant gynecological cancer in women in low Income Countries (LIC) is cervical cancer. The incidence worldwide is 528.000 (year 2012) with a mortality of 266.000. 87% of these cervical cancer deaths occur in women in LIC (Globocan., http://globocan.iarc.fr/old/FactSheets/cancers/cervix-new.asp).
Cervical cancer is preventable: primary prevention involves vaccination with a HPV vaccine of young girls. Secondary prevention involves screening and treatment of pre-malignant cervical lesions. These interventions are feasible in LIC: for example 1 vaccine dose costs USD $ 4.50. Unfortunately, until now, this vaccination is not widely available yet in LIC (Singhrao et al, PLOS, 2013; http://journals.plos.org/plosmedicine/article/asset?id=10.1371/journal.pmed.1001499.PDF). Worldwide, 75 countries have approved the HPV vaccination in their vaccination program, but only a minority of these countries is a LIC.Klik hier om uw eigen tekst toe te voegen
Secundary prevention of cervical cancer is feasible in LIC with cryotherapy or excision of the cervical transformation zone. However this requires training and resources and needs a national commitment of governments and NGOs to combat cervical cancer.
Cervical cancer is treatable in early stages with surgery: however this is technically difficult, and not many gynecologist are trained and equipped to reform these kind of operations in LIC. Sadly many women in LIC present with late stages cervical cancer and need (chemo)radiation therapy. The number of radiotherapy units is low in LIC and the costs of treatment are substantial. In some countries palliative care is available to prevent a painful death.
Cervical cancer is a disease of the poor!
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