Angelina Jolie's Brave Op-Ed Supporting Preventive Cancer Screenings Resonates Internationally

In Ethiopia, we are working to make a particularly important prevention intervention available, to ensure access to cervical cancer screening and treatment for pre-cancerous lesions among one of the most vulnerable populations: HIV-positive women.Angelina Jolie’s recent op-ed about her brave decision to undergo a double mastectomy to prevent breast cancer hit home on many levels. The decision to pursue such a lifesaving and, yes, invasive procedure is not one taken lightly. Though Pathfinder does not work with breast cancer patients specifically, we do work with women in resource-limited settings around the world whose safe access to critical sexual and reproductive health services is a continual issue. We can relate to Ms. Jolie’s story from that perspective, and join in her call to ensure that more women can access needed preventive treatment whatever their means and wherever they live.

In Ethiopia, we are working to make a particularly important prevention intervention available, to ensure access to cervical cancer screening and treatment for pre-cancerous lesions among one of the most vulnerable populations: HIV-positive women. Cervical cancer is a leading cause of cancer mortality among Ethiopian women. For those living with HIV, cervical cancer poses a particular risk for mortality owing to their immunocompromised state.  All told, 22 million women aged 15 and older are considered to be at potential risk for cervical cancer in Ethiopia.

The single-visit approach is a low-tech, low-cost screening and treatment process that combines visual inspection of the cervix with acetic acid wash and, for those found to have precancerous lesions, cryotherapy in the same day. This is particularly important when you consider the distances most women in rural Ethiopia have to travel to seek care. (If they had to come back for a second visit after screening positive, many of them would be unable to complete treatment. Getting it all into one visit is key.) We’ve successfully supported the single-visit approach to be introduced in 14 hospitals across the country. But for women whose lesions are large, cryotherapy is not an option. Until recently, the standard recommendation for these women was a full hysterectomy. Somewhat like the prospect of a double mastectomy, this comes with it deep personal, emotional, and financial considerations for many women. In a resource-limited setting such as Ethiopia, it also brings with it significant cost to the health system, and concerns for infection prevention and quality control.

Ask any Pathfinder and they will confirm this: we are passionately committed to supporting health systems and communities advance the sexual and reproductive health of all those in need. In terms of cervical cancer prevention, this has meant an ever-expanding effort to ensure that minimally invasive, high quality treatment interventions are widely available. Since 2011, this has taken the form of introduction of the LEEP (Loop Electrosurgical Excision Procedure) method to five hospitals across Ethiopia, where the method continues to be used today. LEEP is an outpatient procedure that is lower cost than a hysterectomy (a benefit for resource-limited health systems), and less surgically invasive. Using a thin electrified wire loop, providers remove precancerous tissue. Women receiving the treatment can go home the same day. In receiving our support to introduce LEEP, health systems also gain critical assistance in infection prevention, quality monitoring, and skills training. 

We applaud Ms. Jolie’s call for women to get informed and to seek out medical expertise, because we know how important quality, accessible services are—and how critical it is for women and communities to play a direct role in their own health. We invite you to join us in supporting health systems and communities to realize this in resource-limited settings around the world.Today, more than 13,000 HIV positive women who likely would not otherwise have had access to cervical cancer prevention services have received quality screening thanks to these efforts. A full 95 percent of those found to be in need of treatment have received it.

Despite this tremendous progress, we still have work to do if we are to ensure that all women have access to quality, affordable cervical cancer prevention screening and treatment services. As with any sexual and reproductive health issue, we believe this is part of every woman’s right to health. We applaud Ms. Jolie’s call for women to get informed and to seek out medical expertise, because we know how important quality, accessible services are—and how critical it is for women and communities to play a direct role in their own health. We invite you to join us in supporting health systems and communities to realize this in resource-limited settings around the world. Let’s harness the due attention Ms. Jolie has brought to issues surrounding equitable access to preventive care. Learn more about our cervical cancer prevention work here. Then join us by visiting our “Become an Advocate” page. Let’s do this together.

With funding from the Centers for Disease Control and Prevention (CDC), the Addis Tesfa (New Hope) Project is a collaboration between Pathfinder International, the Ethiopian Federal Ministry of Health, and the Stanford University Program for International Reproductive Education and Services (SPIRES). The project will close in 2014.