ISTANBUL, Turkey — Each year, some 300 women are diagnosed with cervical cancer in the former Yugoslav Republic of Macedonia, which has one of the highest incidence rates of the disease in all of Europe. Though cervical cancer is largely preventable, many countries in the Eastern Europe and Central Asia region struggle to implement effective measures against it.

“Providing equal-quality screening and prevention services as well as treatments for cervical cancer to every woman, no matter her socioeconomic status, is one of the greatest challenges we face,” says Dr. Goran Dimitrov, chief of the Gynaecological Oncology Department at the University Clinic of Obstetrics and Gynaecology in Skopje.

UNFPA’s Eastern Europe and Central Asia Regional Office is working to help medical professionals across the region tackle that challenge with a unique online training course in colposcopy and cervical cancer prevention, created in partnership with the International Federation of Cervical Pathology and Colposcopy (IFCPC), and the International Agency for Research on Cancer. The course is part of broader efforts by UNFPA and its partners to support countries in the region in developing local expertise on comprehensive cervical cancer and control.

Across the Eastern Europe and Central Asia region, more than 38,000 new cases and 18,000 deaths from cervical cancer are registered annually – rates up to 10 times higher than in Western European countries. Poor women, members of minority groups, and women in rural areas, where medical facilities may be limited or substandard, and seeking gynaecological services can be a source of stigma, are often disproportionately affected.

“Creating this training programme was important to help our colleagues in low- and middle-income countries overcome the huge hurdles they face when trying to improve their skills in cervical pre-cancer detection and management,” says Professor Walter Prendiville, past president for Europe of the IFCPC. The programme comprises both online instruction and clinical case management training conducted in a colposcopy clinic under the supervision of a trainer who has already completed the course.

“Due to our joint efforts, this training programme has become available free of charge in both English and Russian in 16 countries and territories in our region, where more than 140 service providers had access to it last year,” says Dr. Tamar Khomasuridze, UNFPA’s Regional Sexual and Reproductive Health Adviser for Eastern Europe and Central Asia. “Based on the success rates the trainees achieved in the international exams at the end of the course, as well as the feedback from participants, we think the programme is ready to roll out in other regions as well.”

Dr. Dimitrov and his colleague Dr. Mukhabbat Akhmedova, a gynaecologist and colposcopy specialist from Uzbekistan, were among the first group of 20 medical professionals from the Eastern Europe and Central Asia region to finish the course and pass an objective structured clinical examination late last year in Lyon, France. They are all now supervising new trainees in their own countries, helping create a cadre of skilled personnel who can push prevention efforts forward.

Importance of a unified national approach

“The course exceeded my expectations and provided a great opportunity to learn from the best experts in the field of cervical cancer about early detection, diagnosis and treatment of precancerous lesions,” says Dr. Akhmedova. “It gave me confidence in the tactics of managing women’s health.”

The Women’s Wellness Centre in Tashkent where Dr. Akhmedova works is already a leader in combatting cervical cancer in Uzbekistan, where some 800 women die each year from the disease. Their team was the first in the country to offer diagnostics and treatment of pre-cancerous lesions using modern procedures, including Pap testing, colposcopy and diagnostic biopsy. The effectiveness of other facilities is still hampered by the lack of a unified national approach on who should be screened, when and how often, as well as a lack of continuity between different levels of the healthcare system.

“Cancer-screening programmes in Uzbekistan and other post-Soviet countries are typically using out-of-date, ineffective methods that don’t rely on evidence, leading to late diagnoses and high mortality,” says Feruza Fazilova, National Programme Officer on Reproductive Health in UNFPA’s Uzbekistan Country Office. “The Women’s Wellness Centre is the only one that currently has the capacity to roll out and implement evidence-based cervical cancer prevention and control.”

Following her completion of the online training course, Dr. Akhmedova is working with the Ministry of Health to revise and update the existing protocols that regulate cervical cancer prevention and control. This UNFPA-supported process aims to boost the effectiveness of healthcare facilities nationwide in fighting cervical cancer.

Updating clinical guidelines and promoting HPV vaccination

The pool of national experts trained with the support of UNFPA and its regional partners forms a crucial basis for further strengthening national capacities for cervical cancer prevention and management, and thus improving quality of care. Many of these experts are participating in healthcare-reform efforts in their countries that will contribute to the enhancement of comprehensive sexual and reproductive health programmes that will avert deaths among women due to cervical cancer.

In the former Yugoslav Republic of Macedonia, Dr. Dimitrov is spearheading UNFPA-supported efforts to update national guidelines for cervical cancer screening and promote widespread HPV vaccination, which is highly effective in reducing cervical cancer rates. High-risk variants of the common sexually transmitted virus HPV can cause cervical cancer, but up to 90 per cent of cases can be prevented through HPV vaccination of adolescents, combined with well-organized screening programmes.

“Health professionals are the most reliable source of information for patients, so having a highly reputable figure like Dr. Dimitrov advocate for broader HPV vaccination coverage is really important,” says Afrodita Shalja-Plavjanska, a National Programme Officer on Sexual & Reproductive Health for UNFPA’s Country Office in Macedonia.

“Doctors are actively working to raise awareness about the HPV vaccine, while the clinical guidelines for cervical cancer screening are undergoing a revision in order to be adapted to modern protocols, emphasizing the future of the HPV testing as a primary screening tool,” says Dr. Dimitrov, who is also president of the Macedonian Medical Association. “These two projects are of enormous significance because of their power to save lives.”