Cervical cancer is a preventable and a highly treatable disease, but nearly 11 Filipinas die from it every day. In the Philippines, it is the second most frequent cancer among women, with around 8,000 new cases diagnosed each year. It is the third leading cause of female cancer death, with over 4,000 deaths annually.
The Philippine Cervical Cancer Elimination Movement (“the Movement”) was launched on 25 May 2023, in a forum organized by ADR Stratbase, in partnership with Jhpiego Philippines, Cancer Coalition Philippines, Philippine Obstetrical and Gynecological Society and UHC Watch. The Movement is committed to reversing the current cervical cancer statistics through collaborative and unified efforts, starting with a Call for Solidarity signed by key stakeholders, and disseminated to the public. The online petition targets at least 11,000 signatures—to give voice to the 11 women who die of cervical cancer every day in the country.
“A woman’s death is both a personal tragedy and a sad, unnecessary loss to her family and community. These deaths are unnecessary because there is compelling evidence that cervical cancer is one of the most preventable and treatable forms of cancer if it is detected early and managed effectively,” said World Health Organization Representative to the Philippines Dr. Rui de Jesus., in a message recorded for the launch.
PATH TO CERVICAL CANCER ELIMINATION
The Philippine Cervical Cancer Elimination Movement enjoins policymakers, legislators, political leaders, private organizations, and civil society organizations to work together to promote and support the World Health Organization’s Global Strategy to Accelerate the Elimination of Cervical Cancer, which aims to achieve the following targets by 2030:
- 90% of girls fully vaccinated with HPV vaccine by the age of 15;
- 70% of women screened with a high-performance test by the age of 35, and again, by the age of 45; and
- 90% of women identified with cervical disease receive treatment (90% of women with precancer treated and 90% of women with invasive cancer managed).
In line with this strategy, the Movement calls for:
- support for women to get vaccinated, screened, and diagnosed;
- national and local government to institutionalize the National Integrated Cancer Control Act (NICCA) provisions on patient navigation, palliative care, and pain management;
- LGUs to include cervical cancer programs and services in their health and development;
- investments in prevention and screening, alongside the provision of adequate funds for scaling up human papilloma virus (HPV) vaccination, HPV DNA screening, and treatment of pre-cancerous lesions and invasive cancer;
- increased coverage and reach of the Philhealth Z-Benefits Package to include HPV DNA Screening;
- private companies to create an enabling cancer policy, which allows for cervical cancer-related benefits to employees and their families;
- platforms for information dissemination, knowledge and experience sharing, co-created by the DOH and its partner agencies; and
- other collaborative and innovative solutions in a whole-of-society approach to combat cervical cancer in the country.
“Continuous support and advocacy from different stakeholders [are] needed to sustain responsive health services in the Philippines,” said Stratbase ADR Institute President and CEO Prof. Victor Andres Manhit, during his welcome address. “We must all work together to make universal healthcare a reality for everyone.”
“We cannot do it alone as oncologists, we have to collaborate with government, with the public health sector, with the community experts, as well as even the pain and rehabilitation specialists,” also noted Philippine Obstetrical and Gynecological Society (POGS) President Dr. Efren J. Domingo, in his keynote address.
CHALLENGES TO THE CAUSE
Dr. Domingo imparted that based on the WHO baseline analysis on Global Cervical Cancer Elimination covering 185 countries: incidence of cervical cancer peaked at age 35 and thereafter remained constant at low levels in higher-income countries with high screening coverage. In contrast, in low or middle-income countries (such as the Philippines), trends are likely to increase in the absence of scale-up preventive interventions such as screening and HPV vaccination.
“Utilization of cervical cancer screening is unfortunately still low in this country. There is a need to increase budget [and] to convince government to put in more personnel as well as instrumentations necessary to achieve the goal,” said Dr. Domingo. He cited unavailability of facilities and expertise, and high out-of-pocket costs for the patient, among the factors of failed cervical cancer screening.
Although landmark Philippine legislation such as the Universal Health Care Act and the National Integrated Cancer Control Act (NICCA) allow for budget allocations from the General Appropriations Act—for example, a combined total of PhP1.56 billion was allocated for the implementation of the Cancer Control Program and the Cancer Assistance Fund for 2023—such budgets are largely focused on cancer treatment and management.
Dr. Jan Aura Laurelle V. Llevado, Cancer Control Division Chief at the Disease Prevention and Control Bureau of the Department of Health (DOH), said that separate funding is needed for prevention and primary care, including HPV vaccination and cervical cancer screening. She noted challenges such as the low uptake of HPV vaccination (7% in 2020, 0.34%, in 2021, and 3% in 2022 for vaccination against HPV) and low utilization of cervical cancer screening (a steep drop from 224,620 to 40,420 women screened in 2020 alone) due to multiple factors, including pandemic-related disruptions.
The DOH is currently collaborating with the HPV Vaccination Acceleration Program Partner’s Initiative (HAPPI) Project to conduct a comprehensive landscape situational analysis, with the intent to use the findings in restoring and maintaining HPV vaccination. The DOH is also considering studying the effectiveness of service delivery models, assessing the benefits of community-based and school-based vaccination drives.
“It is important to introduce vaccination early, and the target should really be to include it in the community and school venues,” opined Dr. Domingo.
NEW STRATEGIES TO COMBAT CERVICAL CANCER
The consortium-led Scale Up Cervical Cancer Elimination with Secondary Prevention Strategy (SUCCESS) Project has been instrumental in introducing (1) simplified cervical cancer screening using HPV DNA testing with self-collection sampling, and (2) treatment of precancerous lesions with thermal ablation. Dr. de Jesus lauded SUCCESS for facilitating the introduction of accessible screening and early treatment for cervical cancer. WHO also endorses HPV DNA detection as the primary screening test in the general population of women and women living with HIV.
Similarly, Dr. Llevado considers HPV DNA testing through self-collection as an effective method given that “it can be done from anywhere”, as long as the patient is connected to a treatment facility with a laboratory that can generate the results. “What we have to do is really to intensify service delivery and forge partnerships, not just for the government, but really for the private sector, and even for the local government units,” Dr. Llevado said.
Dr. Ingrid Magnata, Country Program Manager of Jhpiego Philippines, an affiliate of Johns Hopkins University, and Strategies Lead of the SUCCESS Project in the Philippines, regards self-collection to be a game-changer in cervical cancer elimination. However, patient education is still critical for SUCCESS. She shared that for every 100 women who register for HPV DNA screening in a community in Tondo, only 50 will come during the actual day. Women fear a positive diagnosis—the message must be reinforced that cervical cancer is preventable, treatable, and can be eliminated.
Other forum speakers agreed that the Movement can function not just as a platform for partnership but also of knowledge-sharing and awareness-raising. Dr. Llevado spoke of messaging tailored to market segmentation. Dr. Domingo spoke of using trimedia and youth forums, and emphasizing gender-neutral vaccination., given HPV’s most common route of transmission. “We should involve men,” he said.
Dr. Fatima Gimenez, President of the Pediatric Infectious Disease Society of the Philippines and Chair of the Committee on Immunization of the Philippine Pediatric Society spoke of “laymanizing” terminology and assessing the impact of education materials. “The key messages have to be unified and simple enough for the man or the woman on the street to understand,” she said.
“We need to organize ourselves, we need to systematize all our efforts, and for us to reach the elimination level, we have to scale up and most especially, we need to empathize,” said Dr. Magnata. “The 90-70-90 targets must be met by 2030 for countries to be on the path towards cervical cancer elimination… this is a long shot for all countries, including the Philippines, but we have to start it now.”
Sign the petition: https://www.change.org/p/it-is-time-to-take-action-against-cervical-cancer.