Home Institution

Stanford University

Publication Date

Fall 2006

Program Name

South Africa: Community Health

Abstract

The value of screening for cervical cancer has been proven; as such screening has resulted in a decrease in incidence and mortality of cervical cancer by over 80% in developed countries . Yet despite a screening infrastructure, cervical cancer is the most common female malignancy in South Africa , affecting 1 in ever 41 women. It is estimated that more than 3,400 South African women die of cervical cancer every year . In the year 2000, the South African Department of Health initiated its National Guideline on Cervical Cancer Screening Program. The program, based on World Health Organization (WHO) guidelines for low-resource settings, calls for South African women to receive 3 smears per lifetime with a 10 year interval between each smear, commencing at no earlier than age 30. The ultimate goal is to screen 70% of targeted women, nationally, within 10 years of initiating the program in order to reduce the incidence, morbidity, mortality and cost of cervical cancer. In this study, I evaluate the implementation challenges and content suitability of the 2000 National Guideline on Cervical Cancer Program in KwaZulu-Natal (KZN) by triangulating the data I have collected from interviews with relevant stakeholders in the cervical cancer field, pertinent secondary sources on the topic and my general observations living and studying in KZN from the period of 8 September 2006 to 7 December 2006. The evidence I detail suggests that the current National Guideline on Cervical Screening Program does not appear to be comprehensively implemented in KZN and may not be suitable within the context of the HIV/AIDS epidemic. In this piece, I discuss possible reasons for this alleged failure of implementation, citing evidence that 1) there are inadequate resources in the public sector, that 2) health care workers are overstrained causing i. pap smears to fall low on the list of health priorities, ii. provider attitudes that discourage clinic attendance and iii. a possible information-dissemination failure from healthcare provider to patient and that 3) there is inadequate publicity of the cervical screening program to the public at large. I then discuss data that suggests that even if implemented, the cervical screening policy may not be suitable in KwaZulu-Natal because such a substantial portion of the young female population is infected with HIV. Evidence suggests that HIV decreases the age at which women have cervical cancer, decreases the interval of time from dysplasia to cancer and increases the likelihood of false-negative results of pap smears. As such, HIV-positive women should be getting pap smears at young ages and at frequent intervals. Finally, in an epilogue, I discuss exciting new developments in the cervical cancer field.

Disciplines

Preventive Medicine

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