Ophira Ginsburg, MD
Of the more than 250,000 women who died of cervical cancer across the globe in 2017, 90% of them lived in low- or middle-income countries, according to Ophira Ginsburg, MD. She added that the tools to address this disparity in cancer care exist, but more work needs to be done to eliminate this preventable malignancy.
While the World Health Organization (WHO) has parameters in place for screening women for cervical cancer, Ginsburg said that it will require a collaborative effort from civil society organizations, academia, and medical societies to address the burden of cervical cancer mortality in low- and middle-income countries. Alleviating this obstacle means improving the health system for cancer care more broadly, including introducing technology, infrastructure, and resources used in high-income countries that are appropriate for the resource level of a given low-income country.
In an interview with OncLive
, Ginsburg, director of the High Risk/Cancer Genetics Program at NYU Langone's Perlmutter Cancer Center, discussed cervical cancer prevention, screening, and elimination on a global scale.
OncLive: What is the current state of cervical cancer prevention, globally?
Cervical cancer has been largely addressed in many high-income countries that have had upwards of 40 years of experience of population-based screening programs with cytology, Pap tests, and appropriate access to treatment for precancer. In low- and middle-income countries—what some call developing countries—we are still seeing a tremendous number of women dying unnecessarily of this very preventable disease. Over 250,000 women died last year of cervical cancer, and 9 in 10 of those women were living in a low- or middle-income country. It is the epitome of cancer disparity.
We have the tools, and we know how to prevent and cure cervical cancer in all settings now. The good news is that we know what to do; the question is, “How do we get there?” When I was working at WHO prior to NYU Langone’s Perlmutter Cancer Center, one of my tasks was to work with other agencies involved in a joint program for cervical cancer control. Together, along with civil society organizations, academia, medical societies, and others, we are trying to help countries address this burden by finding pragmatic, tailored solutions that are appropriate for their resource level and would fit within their health system.
One of the opportunities in tackling cervical cancer prevention and control in low- and middle-income countries is that it can actually help to do a few other things that are not necessarily obvious. First is to improve the health system for cancer control more broadly. You have to bring to the mix the importance of radiotherapy, brachytherapy, and other therapies for invasive cervical cancer—these technologies, resources, infrastructure, and training are really important to address the cancer burden more broadly. Cervical cancer is what many in global health call the "low-hanging fruit" of cancer control because we have all of these tools, including cost-effectiveness data and WHO recommendations that are very clear to help advise countries. We can demonstrate what can be done in cancer more broadly in the poorer countries of the world.
Until now, many countries were reluctant, and quite understandably resistant, to allocating any resources toward cancer. This is because it is usually thought of as an expensive disease to treat, impossible to prevent, and requiring of major vertical investments in infrastructure. If you think about how long it takes to train a medical oncologist and how expensive it is to purchase a linear accelerator or a brachytherapy unit, you can see why countries might be put off by that. With cervical cancer control, so much can be done upfront through primary prevention through vaccination. Treatment of precancer by more pragmatic, less expensive, and more effective strategies, such as visual inspection with acidic acid (VIA) are opportunities to prevent and treat cervical cancer without an oncologist even being involved.