Addressing Global Cervical Cancer Disparities with New Resource-Stratified Guideline

Addressing Global Cervical Cancer Disparities with New Resource-Stratified Guideline

Jonathan S. Berek, MD, MMedSc, FASCO

May 25, 2016

Today ASCO issued its first clinical practice guideline on invasive cervical cancer, with recommendations organized according to health system resource availability levels. I was honored to serve as Co-Chair of the Expert Panel that developed the guideline, along with Dr. Linus Chuang.

We know that access to cervical cancer care is extremely variable around the world, both among countries and within them. In low-resource settings, patients typically don’t have access to cervical cancer screening and present with advanced disease at diagnosis, requiring services and treatments, such as radical surgery and chemoradiotherapy, that may not be readily available where they live. Radiotherapy shortages are particularly acute in these settings.

Deaths from cervical cancer—a largely preventable disease—are tragically common in such settings. In fact, 87% of deaths from cervical cancer occur in low- and middle-income countries. At least two-thirds of cervical cancer deaths occur in women who hadn't been screened regularly.

This new guideline provides evidence- and formal consensus-based recommendations for four resource tiers: basic, limited, enhanced, and maximal. For each setting, and for each stage of cervical cancer, the guideline recommends optimal therapy and palliative care. I encourage you to read the guideline in full and explore its supplementary materials, and then share your feedback on ASCO’s guidelines wiki.

It was a pleasure to work with Dr. Chuang and the multidisciplinary panel of experts to conduct the literature review and develop this guideline. Panel members brought expertise in cancer control; gynecologic, medical, and radiation oncology; health economics; obstetrics and gynecology; and palliative care; and patient advocacy. They represented perspectives from the United States, Spain, Mexico, Turkey, Canada, Argentina, Zambia, Uganda, South Korea, China, and India.

We are pleased to report that the guideline has been endorsed by the Society of Gynecologic Oncology and Gynecologic Cancer Intergroup.

If we improved cervical cancer screening and HPV vaccination around the world, we might be able to substantially decrease the mortality from cervical cancer. ASCO is also developing two resource- stratified guidelines, one on screen-and-treat strategies and the other on HPV vaccination. In addition, ASCO has produced a policy statement on HPV vaccination.

Regardless of resources, health care providers should always strive to deliver the highest level of care to all women with cervical cancer. This guideline is a starting point. We hope that it will generate discussion and much-needed research in the field.


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