FOREWORD Cervical cancer is one of the commonest cancers diagnosed in women in South Africa. The main cause of cervical cancer is infection of the cervix by the Human Papillomavirus (HPV), of which strains 16 and 18 are the most common types associated with the development of cervical cancer. Cervical cancer is a relatively unique cancer in that it has a long precursor phase, during which risk and abnormalities can be detected by screening. Screening can now be done by both the Papanicolaou cytology test (Pap smear) and by detecting persistent infection with high risk types of HPV. Positive screening tests, left untreated put a woman at high risk of progressing to cervical cancer over a 5 – 30 year period. Once these abnormalities are detected and treated, progression to invasive cancer of the cervix can be prevented. The National Department of Health has a based programme in place to address several women’s health issues, including cancer of the cervix. Organized cervical cancer screening for eligible women is the central element within the existing cervical cancer prevention strategy of the Department. This policy updates the existing strategy to take into account technological advancements in cervical cancer prevention and new evidence on prevention, approaches and methods in context of the HIV epidemic. This updated policy also provision for the introduction of primary prevention of cervical cancer through HPV vaccination of young girls aged 9-13years, and the promotion of awareness regarding HPV prevention through safe sex practices and dual protection (barrier plus other methods of contraception). It provides for secondary prevention through strengthening cytology screening and introducing test-and-treat in resource-limited settings, where treatment follows immediately after a positive screening test; and HPV DNA-based screening where resources permit, in the public sector (WHO guidelines, 2013). The policy makes provision for all HIV negative, asymptomatic women over the age of 30 years attending public sector health services to undergo three free cervical cancer screening tests at ten year screening intervals. It also introduces new guidelines for cervical cancer screening for HIV positive women. Screening these target groups has been proven through numerous international and trial
The following are factors contributing to high incidence rates, especially among Black and HIV-positive women. These factors have therefore been taken into consideration in this revised policy: Socio economic status and place of residence (urban versus rural): Women who live in rural areas are disadvantaged regarding access to appropriate information and access to services. In some cases where a woman has access to a primary health care facility for screening, the referral to the next level of care is delayed due to poverty or financial challenges. Educational level: The default community messaging strategy is through written material. Furthermore the medium of communication is in English, which excludes most of the women living in rural areas, whose first language of communication is not English. Social arrangement of the family: Women in some communities are largely not decision makers in relation to health seeking patterns, especially sexual and reproductive health issues, because of their economic reliance on their male partners. In other communities the decision to seek medical advice is made by the elderly woman in the family who may not be adequately informed. Access to services: The health care system in South Africa is still largely with a focus on curative care. In addition, the availability of specialised health care services in South Africa is not equitably distributed according the needs of the community. Thus there are areas where advanced services are available and accessible while other parts of the country only offer basic health care services. The situation is exacerbated by the severe shortage of specialists such as oncologists, radiation oncologists, appropriately trained surgical specialists and oncologically trained nurses. Health care worker skills: There are challenges with inadequately trained health care workers, which contributes to a delay in diagnosis and referral to the next level of care for definitive treatment. Stigma: Due to the stigma associated with cervical cancer, patients tend to seeking treatment early or even disclosing the condition.