HPV and cervical cancer in developing countries

The Human Papillomavirus (HPV) is one of the most common causes of sexually transmitted disease in both men and women worldwide. It is the leading cause of cervical cancer, and the second biggest cause of female cancer mortality worldwide with 288 000 deaths annually. It remains a comparatively rare disease, with other causes of death such as lower respiratory infections, coronary heart disease, tuberculosis amongst many diseases and conditions being far more common. However, it is interesting to note that, by comparing cervical cancer with other leading causes of death, there is a clear distinction between the lower and higher income groups across regions. There are approximately 510,000 cases of cervical cancer reported annually with nearly 80% in developing countries, more than half of whom are in Asia.

Although reproductive health in general and cervical cancer prevention in particular are not explicitly mentioned as part of the UN Millennium Development Goals (MDGs), it is implied and cervical cancer has significant impact on poverty, education, and gender equity which are the first three MDGs. It may be useful to explore improved cervical cancer prevention as a way to support development as well as to evaluate the benefits that could be gained in relation to interventions that target other diseases in developing countries.

The cervical cancer screening measures in place in developed and resource-rich countries such as North American and European nations have appeared to have attained some measures of success in reducing morbidity and mortality. However, similar attempts to pursue a strategy of wide-ranging and frequent screening of cervical cancer have not necessarily been as successful in developing countries. The differing results of such programmes in developed and developing nations highlights the need to identify more cost-effective screening or prevention methods such as a HPV vaccine which are affordable to developing countries, which have to weigh the benefits of such a vaccination programme alongside existing immunisation schemes and emerging new vaccines. Countries also have to take into consideration the importance of cervical cancer as a cause of mortality in relation to other diseases to be able to ascertain the time and resources that should be expended on different control strategies, perhaps through the use of methods such as examining the years of life lost as an indicator of disease burden.

The successful implementation of an adolescent HPV vaccination programme may create opportunities for strengthening health systems through the establishment of new mechanisms for vaccine delivery and surveillance of impact. There are many challenges to the implementation of such a programme, but an attempt to identify means of providing HPV vaccinations to adolescents in developing countries may help to address other similar challenges to existing health systems. It is imperative to explore the possibility of cooperation between governments and international organisations, and within countries amongst reproductive health, immunisation, child and adolescent health and cancer control programmes.It is only through such cooperation that  the impact of diseases such as HPV and other preventable and curable diseases on populations in developing countries may be mitigated.