Conduct Organized Campaign on Cervical Cancer Screening Program

- The Health Policy Brief

I. Introduction
Fact Sheet 2019.HPV Information Centre & PMC Articles

Philippines has a population of 34.3 millions women ages 15 years and older
who are at risk of developing cervical cancer. Current estimates indicate that
every year 7,190 women are diagnosed with cervical cancer and 4,088 die
from the disease. Cervical cancer ranks as the 2nd most frequent cancer
among women in Philippines and the 2nd most frequent cancer among women
between 15 and 44 years of age.

INCIDENCE MORTALITY
Annual number of new cases/deaths 7,190 4,088
Crude rate 13.60% 7.70%
Age-standarized rate 14.90% 8.80%
Cumulative risk 0-74 years (%) 1.60 1.0
Ranking of cervical cancer (all years) 2nd 3rd
Ranking of cervical cancer (15-44 years) 2nd 3rd
Table 1. Burden of cervical cancer

Indeed, women detected with precursor and/or very early disease stage then
managed appropriately, have 5-year survival rates of 100% & 68-90%
respectively. Detection and management is more efficiently provided by an
organized cervical cancer screening program rather than convenience or
spontaneous cervical cancer programs.
Sadly, the Philippines does not have any organized cancer-screening program.
A cancer registry covers only 25% of the country’s population. There is no
routine recording of the proportion of the population who undertake
cancer-screening tests. There is an acknowledged lack of public knowledge
and awareness of the benefits of cancer-screening tests. And cancer
screening is not given importance in the education and training of health
professionals.

The government cancer-screening infrastructure is patchy at best with

intermittent supplies, training and service provision. The private health care
delivery sector is not even obligated to participate in a convenience-screening
program with its screening guidelines always emphasizing its recommendatory
nature and the absence of sanctions and incentive for compliance And there is
no mandate for the continuity of care expected from a screening program from
health providers.

II. Burden of Cervical Cancer in the Philippines

Cervical cancer is the second most common malignancy and is the most
common cause of cancer-related mortality among Filipino women. Although
considered as a preventable disease, the burden of cervical cancer in the
Philippines remains to be moderately high, where the cost of nationwide
organized cytology screening has been a significant limitation. In a country
where existing health infrastructure is not sufficiently developed to support
cytology-based screening program, the use of alternative screening modalities,
such as visual inspection of the cervix aided by acetic acid (VIA) with or
without magnification, is currently under evaluation. In addition, prophylactic
Human Papillomavirus (HPV) vaccination for the prevention of infection and
related disease is being considered as an additional cervical cancer control
strategy.

Risk factors for HPV infection and cervical cancer in the Philippines are similar
to those reported in other countries. The prevalence of some co-factors,
including smoking, oral contraceptive use, and fertility, for cervical
carcinogenesis in the Philippines.

Table 2. Prevalence of smoking, oral contraceptive use and total fertility in the
Philippines
 Co-factors Prevalence (%)
Current Smoking 8.1
Ever use of contraception 13.2
Total fertility rate (per woman) 3

High-risk human papillomavirus (HPV), an infectious agent, types, such as 16

and 18, are consistently identified in Filipino women with cervical cancer.
Factors identified to increase the likelihood of HPV infection and subsequent
development of cervical cancer include young age at first intercourse, low
socioeconomic status, high parity, smoking, use of oral contraception
and risky sexual behaviors. Cancer screening programs presently available
in the Philippines include Pap smears, single visit approach utilizing visual
inspection with acetic acid followed by cryotherapy, as well as colposcopy.

Table 3. Burden of cervical HPV infection Philippines

No. Tested % (95% CI)

HPV prevalence in women with 377 9.3 (6.8-12.6)
normal cytology
HPV 16/18 prevalence:
Normal cytology 377 2.9 (1.6-5.1)

Cervical cancer 712 58.6 (54.9-62.1)