Cervical cancer prevention in South Africa : HPV vaccination and screening both essential to achieve and maintain a reduction in incidence

Abstract

Cervical cancer remains an important cause of morbidity and mortality in South Africa (SA). A national cervical cancer prevention programme exists that offers three cervical cytology smears per lifetime, starting after the age of 30 at 10-year intervals. Despite this programme the incidence remains unacceptably high, cases are often diagnosed late, and many patients have poor response to treatment. Primary healthcare systems in many areas are poorly developed, and uptake of cytological screening is generally poor, with some metropolitan areas and regions doing slightly better. Health systems interventions are necessary to improve the quality of screening. In addition, there is often significant loss to follow-up after the initial screening test among women identified with abnormal cytology. Determinants of the high cervical cancer rate and poor outcome of treatment are similar to those in other developing countries and include a low doctor/population ratio, a high prevalence of HIV infections, and competing healthcare needs. A lack of consumer (patient) knowledge and empowerment leads to a low degree of health-seeking behaviour.