Cervical cancer is the second commonest cancer among women of reproductive age group in PNG. In 2002 there were 200 new cases reported at the Port Moresby General Hospital. And the incidence is rising. There have been much publicity about this increasing incidence and the need to do reduce it, but there has been a lack of concerted effort to do something about it. A document has also not been prepared to clearly outline the measures that will and need be taken to reduce the number of women dying of cervical cancer each year. I would like to give my suggestions and they are; education and awareness, screening program, surgery with or without radiotherapy, and palliative care for terminal cases.
Education and Awareness
I think educating and making women in the reproductive age group aware of what cervical cancer is, the signs and symptoms of cervical cancer, and what the risk factors are is the only way for reducing the high mortality rate in developing countries in the abscence of a national Pap smear screening program. There are many ways on how we can go about implementing the education and awareness programs.
The programs can be incorporated into existing education and awareness programs for maternal and child health (e.g. MCH clinics, ANC clinics), programs for STIs, (e.g. STI clinics), building it into senior high school curriculums (as part of sexual education), or any other programs that I may have not included. This will ensure women having very basic knowledge about cervical cancer from high school to be more familiar with cervical cancer when attending health talks before the beginning of a clinic, say a MCH clinic. Also the repetition of the same message reinforces what they already know and builds on the basic knowledge.
Early Surgery and Radiotherapy
Early surgery is possible if presentation is early. This makes the education and awareness of the early possible signs and symptoms of cervical cancer more important. The Women Doctors Association of PNG have been very vocal on the issue and thanks to their dedication the government has finally listened and budgeted for the radiotherapy unit in ANGAU hospital in Lae to be revived.
Pap Smear Screening Program
National Pap smear screening programs has dramatically reduced the mortality caused by cervical cancer dramatically in developed countries. However, in countries like PNG (and other pacific island countries) many people may think that Pap smear in a developing country may not be cost-effective. Some of the reasons may be that we think a national program for Pap smear test would need a lot of funding, and this is probably true. The initial cost of establishing the infrastructure, the network and training of human resources in itself may cost a lot more even before the program is launched. However experience in other developing countries like Vietnam has shown that a national Pap smear program in developing countries can be cost-effective (less than US$ 0.092 per woman) provided there is external assistance for training of human resources to screen Pap smear slides.
Finally, if nothing else can be done, than I think at least all effort must be made to ensure women with terminal cervical cancer are properly taken of in hospitals. Palliative care is an area that needs to be improved a lot in PNG, especially pain management, so that women who have terminal stage cervical cancer can die peacefully with dignitity as human beings. The visit by Dr Neill Muirden from the International Association for Hospice and Palliative Care in 2001 increased the awareness of cancer and pain management. The onus is now up to us to take it from there do something about it.