Cervical Cancer in Cameroon: A Three Pronged Approach to Increase Awareness, Vaccination, Screening and Treatment

Problem: Cameroon has a disproportionately high burden of cervical cancer due to low awareness that the disease is preventable with prophylactic vaccines, lack of screening and treatment of pre-cancerous lesions, and high prevalence of human immunodeficiency virus (HIV). Between 2007-2013, the Cameroon Baptist Convention Health Services (CBCHS) devised three programs to: (1) increase awareness about cervical cancer; (2) immunize girls aged 9-13 years against human papilloma virus (HPV); and (3) conduct cervical cancer screening and treatment. Approaches: In collaboration with clinicians and researchers at University of Massachusetts and Northeastern University, CBCHS conducted education programs about HPV vaccine and cervical cancer for parents, adolescents, health care workers, and community members. The HPV vaccination demonstration project was implemented in three settings: schools, healthcare facilities, and in communities. CBCHS conducted cervical cancer screening in six sites using a “see and treat approach”. Findings: Following approval by the Ministry of Health, CBCHS nurses educated girls, parents, and communities about HPV, cervical cancer, and HPV vaccine through multimedia coverage. A total of 6,851, 6,517 and 5,876 girls were immunized with first, second and third doses, respectively. Achieving an 84.6% 3-dose completion rate. Since 2007, 30,617 women have been screened with visual inspection with acetic acid and digital cervicography. Women with precancerous lesions were treated with cryotherapy or loop electrical excision procedure. Lesions suspicious for cancer were biopsied for histology. Of those screened, 3,015 (10%) self reported HIV-positivity, 19,837 (64%) were HIV-negative, and the HIV status of the remaining women was unreported (25%). The percentage of HIV infected women diagnosed with cancer was consistently higher than the percentage of HIV uninfected women diagnosed with cancer. Lessons Learned: The project demonstrated that, with adequate education of stakeholders, HPV vaccination and cervical cancer screening programs are acceptable and feasible methods to improve cervical cancer outcomes in Cameroon.