A 19-year-old HIV-positive single mother of a young child came to the cervical cancer screening clinic in Zambia. The health worker conducted a visual inspection with vinegar and discovered that the young mother had invasive cancer of the cervix. The patient succumbed to the disease within a short period – leaving her young child orphaned. Such aggressive cervical cancer in a teen would be considered rare in most developing countries. But doctors in countries with a high prevalence of HIV infections are seeing it more frequently.
In an attempt to combat this new enemy, the George W. Bush Institute, the United States President’s Emergency Plan for AIDS Relief (PEPFAR), Susan G. Komen for the Cure, and the Joint United Nations Programme on HIV/AIDS (UNAIDS), launched the Pink Ribbon Red Ribbon (PRRR) women’s health initiative in September 2011. Currently with $85 million in commitments, PRRR is a unique partnership that leverages the PEPFAR platforms and investments in the public and private sectors to expand the availability of vital cervical cancer prevention, screening and treatment – especially for HIV-positive women who are at greatest risk of developing cervical cancer. PRRR also promotes breast cancer awareness education in sub-Saharan Africa and Latin America. Corporate partners include Merck; Becton, Dickinson and Company; QIAGEN; Caris Foundation; Bristol-Myers Squibb; GlaxoSmithKline and IBM. IBM’s vital role in PRRR is to support the government of Kenya in implementing health information management systems.
In a recent Hoover Institution article entitled Reshaping Global Health, the authors write that “the focus on specific diseases has exposed fault lines in delivering services in places where people suffer from multiple health issues.” This has never been truer! PRRR was established to repair these fault lines where HIV/AIDS is a joint threat with certain cancers – attacking breast and cervical cancer by leveraging the PEPFAR platform created under President George W. Bush. PEPFAR has saved millions of lives, so instead of setting up parallel services PRRR is focusing on an integrated, holistic approach to fighting women’s cancers. The PRRR initiative addresses cancers at all stages, including education and awareness, primary prevention, screening, simple and more complicated treatments, and palliative care.
Both The Lancet and Harvard’s Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries (GTF.CCC) have lauded PRRR. GTF.CCC praised the program in its 2011 Closing the Cancer Divide report as a “promising innovative resource mobilization and service delivery initiative” that is “designed to expand the availability of cervical cancer screening and treatment – especially for high-risk HIV positive women –
and to promote breast cancer education by leveraging existing HIV/AIDS platforms and PEPFAR investments.”
The World Health Organization’s International Agency for Research on Cancer (IARC) reports that breast cancer is the most frequently diagnosed cancer in women worldwide – affecting an estimated 1.4 million women each year, and killing 460,000 of them (33 percent). The IARC estimates that breast cancer also is the most common cancer among African women – killing nearly 50,000 (54 percent) of the 93,000 who are diagnosed with the disease each year. For cervical cancer, the IARC estimates that more than 525,000 women develop the disease each year, out of which 53 percent – 275,000 – will die. Approximately 18 percent of women who die from cervical cancer are from sub-Saharan Africa, as are 11 percent of women who die from breast cancer.
The great tragedy is that these cancer deaths can be prevented inexpensively. It costs less than $400 to save a life-year from breast cancer when the disease is caught early. Screening and treatment for cervical cancer is similarly inexpensive – costing only a few dollars for tests that can be done with household vinegar, and about $500 to remove early-stage lesions with liquid nitrogen. PRRR seeks to reduce cervical cancer deaths in sub-Saharan Africa by 25 percent over the next five years, and significantly increase access to breast and cervical cancer prevention, screening and treatment.
In regions where the stigma of cancer as “destiny” or a death sentence persists, it is critical to provide accurate, culturally appropriate information and education about the disease. But as awareness increases, so will demands for treatment – often in areas where services are limited or non-existent. That’s why it is critically important to expand sub-Saharan Africa’s health care infrastructure – which only can be accomplished through partnerships between the private sector and local non-governmental organizations.
Doyin Oluwole, M.D., MRCP, FRCP, FWACP, is Founding Executive Director of the Pink Ribbon Red Ribbon Initiative of the George W. Bush Institute. Dr. Oluwole is a native of Nigeria.