Editorial: Integrating Cervical Cancer Screening and Precancer Treatments

Noleb Mugisha¹Leeya F Pinder²Manoj Menon^3*

• ¹Uganda Cancer Institute (UCI), Kampala, Central Region, Uganda
• ²College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
• ³Fred Hutchinson Cancer Center, Seattle, United States

Given the relatively low rates of cervical cancer screening in Ethiopia, Yosef et al, via a hospital-based case-control study demonstrated that knowledge of cervical cancer screening and proximity to the health facility were associated with cervical cancer screening [Frontiers | Determinants of cervical cancer screening uptake among reproductive-age women in southwest Ethiopia: a case-control study]. Recognizing the vital need of cancer awareness, Ouedraogo et al. organized a workshop, consisting of representatives from the relevant stakeholders-including government, non-governmental organizations, civil society organizations, and academic/research organizations, to craft and tailor effective health education and communication strategies [Frontiers | Cervical cancer prevention in Burkina Faso: a stakeholder's collaboration for the development of awareness messaging].To assess the availability and capacity of cervical cancer screening and treatment services in Kenya, Mwenda et al. conducted a sub-national survey of healthcare workers in over 3,000 hospitals [Frontiers | Baseline assessment of cervical cancer screening and treatment capacity in 25 counties in Kenya, 2022]. Only 5% of hospitals provided both cervical cancer screening and treatment services -a disparity which will need to be addressed in order to achieve the WHO targets.The prevention of cervical cancer incorporates both primary prevention strategies, via an effective vaccine, as well as secondary prevention, via treatment of pre-cancerous lesions. To inform the implementation of the most effective vaccine, Kebede et al. describe the prevalence and variation of HPV genotypes [Frontiers | Prevalence and distribution of human papillomavirus genotypes in women with abnormal cervical cytology in Ethiopia: a systematic review and meta-analysis]. Given that prevalence of genotypes which are not included in the commonly used bivalent or quadrivalent HPV vaccine, such information can help advocate for nonavalent vaccine.Hypothesizing that with increased utilization of the HPV vaccines, the genotypes of HPV may vary among those vaccinated and those unvaccinated Yang et al. conducted a study among women with atypical squamous cells of undetermined significance (ASCUS)[ Frontiers | Comparative study of triage strategies for women with atypical squamous cells of undetermined significance in the post-vaccine era]. These researchers concluded that genotype identification may inform the choice of triage options for women identified to have ASCUS lessions on cervical cytology screening. Although the goal to increase HPV remains, cost-effective triage strategies are particularly necessary in resource-limited regions.Lee et al explored the feasibility and acceptability among women undergoing various HPV-based screentriage-treatment options, including self-collected vaginal samples [Frontiers | Experiences of women participating in a human papillomavirus-based screen-triage-and treat strategy for cervical cancer prevention in Malawi]. These researchers offer specific strategies, including the need for health education to optimize perspectives and utilization of cervical cancer prevention services. To minimize the invasive procedures, Qian and colleagues investigated the safety and efficacy of the non-invasive 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in the treatment of high-grade squamous intraepithelial lesions [Frontiers | The efficacy and safety of local 5-aminolevulinic acid-based photodynamic therapy in the treatment of cervical high-grade squamous intraepithelial lesion: a single center retrospective observational study]. Although ALA-PDT has been used in low-grade squamous intraepithelial lesions, these researchers found that the treatment was safe -with no severe adverse effects, as well as effective -with a 12-month complete regression rate of over 80%.There is nothing that can prevent me from supporting her:" men's perspectives on their involvement and support of women's use of topical therapy for cervical precancer treatment in Kenya]. These colleagues also encourage health education strategies which reach the partners of patients undergoing cervical precancer treatment.Given the need for cost-effective strategies for the diagnosis and treatment of cervical cancer and precancerous lesions and recognizing the pathogenesis of cervical cancer, Gong et al, developed a Classification of Lesion Stages (CLS) algorithm to predict the risk of cervical cancer [Frontiers | Predicting cervical intraepithelial neoplasia and determining the follow-up period in high-risk human papillomavirus patients]. The use of such technology may optimally triage patients with pre-cancer lesions, reduce the number of unnecessary procedures, and potentially alleviate the burden on health systems.Although the screening modalities vary among resource-abundant and resource-limited regions, the benefits of resource-relevant screening are clear. An obvious challenge of cervical cancer screening programs is the limited funds dedicated to cancer prevention. Tran and colleagues utilized a simulation model of the current standard of care (i.e. cytology and colposcopy triage) with various scenarios calculated the disability-adjusted life-years (DALYs) averted for each scenario[Frontiers | Costeffectiveness of single-visit cervical cancer screening in KwaZulu-Natal, South Africa: a model-based analysis accounting for the HIV epidemic]. These researchers demonstrated that repeat HPV DNA testing was associated with the highest DALY averted.Clinical services in LMICs are often funded and provided in a vertical fashion with the appropriate integration of relevant infrastructure [12,13]. Because many health systems do not have a primary care model of service delivery, there has been increased recognition of the need to leverage and incorporate non-communicable disease (NCDs) care, including cancer care, within the existing routine services. The benefit of such integration has been demonstrated for certain NCDs, including hypertension and diabetes [14,15]. However, despite the clinical burden, such an integrated approach has not been fully implemented for the early detection of cervical cancer and precancer care treatment.The articles in this research topic highlight the burden of cervical cancer as well as necessary strategies to decrease the toll which disproportionately impacts LMICs. Although effective vaccines to prevent cervical cancer and screening techniques to identify pre-cancerous lesions exist, disparities persist with regard to clinical access. As such, the unnecessary burden cervical cancer remain. Further cost-effective efforts to incorporate the findings demonstrated in this special issue and specifically integrate cervical cancer screening and precancer treatment programs within existing health care programs are necessary to achieve the WHO cervical cancer elimination targets.