Primary and secondary prevention of cervical cancer in Tanzania
Accounting for more than 50% of all new female cancer cases, cervical cancer is the most common malignancy in Tanzania. Many of these cancer cases could be avoided through primary (vaccination) or secondary prevention (screening). When it comes to primary prevention, a proper characterization of the different HPV types is essential for a successful implementation of HPV vaccination. The impact of a vaccine on reducing cervical cancer mortality will not be measurable for decades to come; therefore new vaccines will need to be introduced in conjunction with secondary prevention by screening and treatment of precancer. A screening strategy based on visual inspection with acetic acid (VIA) has been implemented in Tanzania. However, so far less than 1% of the targeted population has been reached by the service. To improve cervical cancer prevention in Tanzania, the study aims to assess the HPV prevalence and type distribution and to identify possible screening barriers. The study is conducted as a close collaboration between the National Cancer Institute in Tanzania, the Danish Cancer Association and University of Copenhagen. In all 4000 women will undergo screening for cervical cancer by VIA and pap smear. The women’s HIV and HPV status will be determined and information about socio economic and reproductive characteristics will be obtained. HPV type distribution and HPV risk factors will be analyzed according to the women’s HIV status. The study will further identify and describe possible barriers for screening attendance. It is believed that the study will provide important information which will assist policymakers and planners in improving the health system to better target the problem of cervical cancer through improved primary and secondary prevention.