Collections > Master's Papers > Gillings School of Public Health > A Policy Analysis of Cervical Cancer Prevention in Honduras

In most developed countries, prevention programs using Pap screening have resulted in impressive decreases in cervical cancer morbidity and mortality over the past 50 years. However, in the developing world, it is quite a different story. In these countries, where over 80% of cases occur, cervical cancer is the leading cause of cancer death among women (Pisani, Parkin and Ferlay 1999). Globally, cervical cancer has been estimated to account for 2.1% of deaths among women aged 25-64, but in Latin America it accounts for 3.8% of these deaths (Parkin, Bray aud Ferlay 2001). Because women in these age groups are fundamental to the fabric of life, not just within families but within economies and societies at large, the toll of this disease is significant. The reasons for this disproportionate burden throughout Latin America are not yet completely understood but are thought to be due in part to the high prevalence of human papilloma virus (HPV) and an inadequate health infrastructure to deal with incident cases (Eluf-Neto and Nascimento 2001). I suggest that this burden is also due to the inadequacies of current prevention programs. This is an ideal time to reconsider cervical cancer prevention in the developing world. We now have a clear understanding of cervical cancer as a rare but possibly fatal complication of a sexually transmitted disease. After several decades of research, we know that HPV is a necessary but not sufficient cause of cervical cancer (Walboomers, Jacobs and Manos 1999). New methods for detecting infection with HPV, as well as new techniques for detecting cervical dysplasia, provide a unique opportunity to re-examine our efforts to decrease suffering from this preventable illness, especially in the developing world. Aside from medical advances, international collaboratives such as the Alliance for Cervical Cancer Prevention (ACCP) are directing funding, research, and model programs toward preventing cervical cancer, particularly in the developing world. We need to evaluate the potential effects of this confluence of new technology, knowledge, and interest among international donors on this important women's health issue. In this paper, I analyze the most effective way to approach cervical cancer prevention in Honduras. Honduras has a twenty year history of a national, Pap-based prevention program yet still suffers from mortality rates approximately five times higher than those in the United States. In an effort to re-consider these efforts, I examine three different cervical cancer prevention policies: the government's current Pap-based approach; a see-and-treat approach (visual inspection with acetic acid followed by cryotherapy as necessary); and HPV vaccines. Using the medical and health systems literature, field notes, and key informant interviews, I evaluate each of these strategies along the following six criteria: efficacy, effectiveness, cost-effectiveness, acceptability, feasibility and equity. Despite significant resistance on the part of providers, I recommend a see-and- treat approach as the most cost-effective and equitable policy for decreasing cervical cancer incidence and mortality in Honduras.