Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective

Abstract

BackgroundWomen living in Africa experience the highest burden of cervical cancer. Research and investment to improve vaccination, screening, and treatment efforts are critically needed. We systematically reviewed and characterized recent research within a broader public health framework to organize and assess the range of cervical cancer research in Africa.MethodsWe searched online databases and the Internet for published articles and cervical cancer reports in African countries. Inclusion criteria included publication between 2004 and 2014, cervical cancer-related content pertinent to one of the four public health categories (primary, secondary, tertiary prevention or quality of life), and conducted in or specifically relevant to countries or regions within the African continent. The study design, geographic region/country, focus of research, and key findings were documented for each eligible article and summarized to illustrate the weight and research coverage in each area. Publications with more than one focus (e.g. secondary and tertiary prevention) were categorized by the primary emphasis of the paper. Research specific to HIV-infected women or focused on feasibility issues was delineated within each of the four public health categories.ResultsA total of 380 research articles/reports were included. The majority (54.6 %) of cervical cancer research in Africa focused on secondary prevention (i.e., screening). The number of publication focusing on primary prevention (23.4 %), particularly HPV vaccination, increased significantly in the past decade. Research regarding the treatment of precancerous lesions and invasive cervical cancer is emerging (17.6 %), but infrastructure and feasibility challenges in many countries have impeded efforts to provide and evaluate treatment. Studies assessing aspects of quality of life among women living with cervical cancer are severely limited (4.1 %). Across all categories, 11.3 % of publications focused on cervical cancer among HIV-infected women, while 17.1 % focused on aspects of feasibility for cervical cancer control efforts.ConclusionsCervical cancer research in African countries has increased steadily over the past decade, but more is needed. Tertiary prevention (i.e. treatment of disease with effective medicine) and quality of life of cervical cancer survivors are two severely under-researched areas. Similarly, there are several countries in Africa with little to no research ever conducted on cervical cancer.

Treatment of pre- and confirmed cervical cancer in HIV-seropositive women from developing countries: a systematic review

“…There are several treatment modalities for cervical cancer, namely, chemotherapy, surgical management, and radiation therapy [7,11,12]. Treatment modalities for precancerous lesions and cervical cancer are based on the stage of the lesions and available resources; the associated poor outcomes of treatment among HIV seropositive women in developing countries may be due to lack of optimal treatment regimen [10,13]. Most developing countries lack skilled surgeons to carry out radical surgery for cervical cancer, and this has left HIV-seropositive cervical cancer patients with few treatment options.…”

Uterine Cervical Cancer Prevention in Eritrea: Development and Results of a Pilot Project

“…Such favorable conditions are often unavailable in low-income countries, however. No established UCC prevention programs (be the primary or secondary) are currently running in Eritrea [7]. This manuscript describes an educational project that aimed to pave the way to locally-run screening programs for UCC secondary prevention in Eritrea [8].…”

“…No reliable epidemiological information is available on the incidence of UCC in Eritrea [7]. In sub-Saharan Africa, 34.8 per 100,000 women are diagnosed with UCC each year, and 22.5 per 100,000 die of this disease [9].…”

Prevention of Cervical Cancer in Sub-Saharan Africa: the Promises and Challenges of HPV Vaccination

“…In high-income countries, screening by cytology (or 'Pap smears') has been the cornerstone of cervical cancer prevention since the 1940s [11]. National screening programs using cytology have resulted in prevention of up to 80% of cervical cancers in highresource settings [9,11], but screening programs have been less effective at controlling cervical cancer in SSA due to financial, logistical and sociocultural constraints to implementation [12]. Many countries in SSA do not have screening programs and among those that do, coverage rates are frequently low [12,13].…”