Securing global access to innovations in women's cancer care and control.

EDITORIAL URRENT C O PINION Securing global access to innovations in women’s cancer care and control Gottfried E. Konecny A standing ovation is a form of applause where members of a seated audience stand up, while applauding after extraordinary presentations of particularly high acclaim. It is not often that one can witness such enthusiastic recognition when attending a very large busy international scientific conference. However, at the annual meeting of the American Society of Clinical Oncology of 2013, I had the privilege of attending the plenary session presentation of Dr Shastri, in which he spoke on the efficiency and cost-effectiveness of visual inspection with acetic acid (VIA) for cervical cancer screening. Screening with VIA among 150 000 women in rural India by trained paramedical workers resulted in a 31% reduction in cervical cancer mortality [1]. VIA screening is easily implementable and could prevent 22 000 cervical cancer deaths in India and 72 600 deaths in resource poor countries annually [1]. This presentation was followed by a very long applause escalating to a standing ovation of the entire audi- ence of some 10 000 meeting attendees. It struck me that this spontaneous reaction not only reflected the deep appreciation for the work of Dr Shastri and his colleagues in the Department of Preventive Oncology at the Tata Memorial Center in Mumbai India, but it also told me how important it is for the listening oncology community to find solutions for the ever growing disparity in cancer care between low–middle-income countries (LMICs) and high- income countries (HICs). Almost 70% of the global burden of cervical cancer occurs in less developed countries, where it is the second most commonly diagnosed cancer and third leading cause of cancer death among women since access to prevention, screening, and treatment measures considered to be standard of care in HICs is limited in LMICs [2]. In this issue, Pimple et al. (pp. 4–10) address the current developments of cervical cancer preven- tion and control in both LMICs and HICs and attempt to identify new strategies that may help address the gaps in cervical cancer care disparities globally. ˜as-Gonza´lez and Campbell Furthermore, Duen (pp. 11–17) from the Instituto Nacional de Cancerologica in Mexico City review in their article global strategies for the treatment of early and advanced cervical cancer. Their study summarizes standard of care practices for early and advanced cervical cancer, highlights recent advances regard- ing fertility preservation, sentinel node mapping, neoadjuvant chemotherapy, and innovative syste- mic treatments for advanced disease, but also emphasizes that social and economic factors still impede the uptake of recent therapeutic advances in LMICs where many patients have no access to the appropriate resources. Mesko and Kamrava (pp. 18–23) from the University of California review recent advances in external beam radiation therapy, brachytherapy, and stereotactic body radiation therapy for the treat- ment of cervical cancer. Although these advances in radiation therapy for cervical cancer are driving improvements in local tumor control and reducing toxicity rates in HICs, results from large scale com- parative studies with long-term clinical follow-up, including results on cost-effectiveness, are still pending. Such data are incredibly important as they would help define new global treatment standards and as a result facilitate the implementation of these advances in economically less-developed regions. Although preservation of ovaries may be an option in early stage cervical cancer, the ovarian failure rate is still high and many premenopausal women will have reduced or absent ovarian hor- mone production as a result of cervical cancer treat- ment. O’Donnell et al. (pp. 32–41) from the University of Manchester review the complex and controversial area of hormone replacement therapy following treatment for cervical cancer and other gynecologic malignancies. As there is little robust evidence to provide guidance regarding hormone Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA Correspondence to Gottfried E. Konecny, MD, Department of Medicine, David Geffen School of Medicine, University of California, 100 Medical Plaza, Suite 550, Los Angeles, CA 90025, USA. E-mail: gkonecny@mednet.ucla.edu Curr Opin Obstet Gynecol 2016, 28:1–3 DOI:10.1097/GCO.0000000000000244 1040-872X Copyright s 2016 Wolters Kluwer Health, Inc. All rights reserved. www.co-obgyn.com Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.