Cervical Cancer in Botswana: Current State and Future Steps for Screening and Treatment Programs.

Surbhi Grover,Lilie L Lin,Jailakshmi Bhat,Erle S Robertson,Stephen M Hahn,Neo Tapela,Barati Monare,Chelsea Morroni,Susan Mayisela,Metlha Nchunga,Kealeboga Thipe,Balladiah Kizito,Dawn Balang,Anthony H Russell,Ari Ho-Foster,Jason A Efstathiou,Onyinye Balogun,Senate Tanyala,Babe Gaolebale ,Nicola M Zetola ,Sebathu Chiyapo ,Ponatshego Gaolebale ,Mukendi Kayembe ,Memory Bvochora‐Nsingo ,Mmakgomo Mimi Raesima ,Scott Dryden‐Peterson ,Doreen Ramogola‐Masire

doi:10.3389/fonc.2015.00239

Abstract

Botswana has a high burden of cervical cancer due to a limited screening program and high HIV prevalence. About 60% of the cervical cancer patients are HIV positive; most present with advanced cervical disease. Through initiatives by the Botswana Ministry of Health and various strategic partnerships, strides have been made in treatment of pre-invasive and invasive cancer. The See and Treat program for cervical cancer is expanding throughout the country. Starting in 2015, school-going girls will be vaccinated against HPV. In regards to treatment of invasive cancer, a multidisciplinary clinic has been initiated at the main oncology hospital to streamline care. However, challenges remain such as delays in treatment, lack of trained human personnel, limited follow-up care, and little patient education. Despite improvements in the care of pre-invasive and invasive cervical cancer patients, for declines in cervical cancer-related morbidity and mortality to be achieved, Botswana needs to continue to invest in decreasing the burden of disease and improving patient outcomes of patients with cervical cancer.

Highlights

Cervical cancer is the second most common cancer in women in low- and middle-income countries (LMICs), with an estimated 530,000 new cases each year
The Government of Botswana has recognized the burden of disease that cervical cancer poses, and, as a result, for the last two decades, has attempted to provide screening in the form of cytology
These programs have had a limited impact on cervical cancer incidence and mortality due to challenges with follow-up, as well as pathological and treatment capacity in a setting where screening results are positive for a high proportion of women

Summary

INTRODUCTION

Cervical cancer is the second most common cancer in women in low- and middle-income countries (LMICs), with an estimated 530,000 new cases each year. The Government of Botswana has recognized the burden of disease that cervical cancer poses, and, as a result, for the last two decades, has attempted to provide screening in the form of cytology These programs have had a limited impact on cervical cancer incidence and mortality due to challenges with follow-up, as well as pathological and treatment capacity in a setting where screening results are positive for a high proportion of women. The strategy calls for the dual use of VIA and Pap smear (use of either methods) for wider screening coverage for women aged 30–49 years (the highest at-risk group for precancer) Implementation of this strategy, in part, will be made possible by additional PEPFAR funding through the pink ribbon red ribbon (PRRR) initiative of the Bush Foundation. During periods of extended backlog, the MOH has utilized the private sector to expedite timely pathology results

CERVICAL CANCER VACCINATION

CERVICAL CANCER TREATMENT

Findings

CHALLENGES AND FUTURE DIRECTIONS