Cervical Cancer Prevention and Control in Senegal

In 2010, the Kedougou Medical Region in Southeastern Senegal, the Institute of Health and Development at Cheikh Anta Diop University, Dakar, Senegal, and the University of Illinois at Chicago (UIC) formed a partnership to implement CC prevention services. Between 2010 and 2013, the partnership worked to build capacity across Kedougou to ensure cervical cancer (CC) screening access for an estimated 9,041 women in the targeted age group. Despite robust community-level education, CC screening rates were suboptimal with less than 5% of the population being screened in some locations.1 Our 2014 study concluded that only 38% of women in the study area were aware of CC, highlighting lack of awareness as a major barrier to women accessing screening services.1 In 2016, this partnership received K01 (PI: Dykens) funding from the National Institutes of Health (NIH) Fogarty International Center (FIC) to study the implementation of a peer-education behavioral change communications strategy to motivate women to seek CC screening. In late 2018, Senegal launched a nationwide HPV vaccine initiative with a focus on 9 year old girls.2 Our 2018 study showed that 76% of mothers had no HPV vaccine awareness. In addition, findings demonstrated that misinformation was contributing to HPV vaccine hesitancy. Concurrently, with direct input from the UIC-Senegal partnership’s efforts and experience, the Senegal MoHSA prioritized an effort to develop a National Cervical Cancer Prevention and Control Plan (NCCPCP) that prioritizes CC screening implementation in the rural zones, launched in early 2020. Subsequently, through a Rotary International Global Grant initiated in late 2019, our partnership worked closely with the Senegal MoHSA to scale CC screening services to the neighboring region of Tambacounda. We used a Training of Trainers approach to conduct a total of 28 trainings in 2020 (through responsible adaptations consistent with local policies regarding COVID-19 prevention). We trained a total of 695 health personnel (administrators, midwives, and community health workers) across 182 facilities in all seven districts of the Tambacounda Region (bordering Kedougou) in Southeastern Senegal and screened 1,897 women. Screening is currently available in all proposed study sites. Senegal guidelines recommend CC screening by way of visual inspection of the cervix with acetic acid3,4 every two years for women ages 25 to 69. Cervical precancers are treated with thermocoagulation and suspected CCs are referred to tertiary care centers in Dakar.5 

1. Dykens JA, Linn AM, Irwin T, Peters KE, Pyra M, Traoré F, et al. Implementing visual cervical cancer screening in Senegal: a cross-sectional study of risk factors and prevalence highlighting service utilization barriers. Int J Womens Health [Internet]. 2017 Jan 27;9:59–67. Available from: http://dx.doi.org/10.2147/IJWH.S115454
2. Casey RM, Adrien N, Badiane O, Diallo A, Roka JL, Brennan T, et al. National introduction of HPV vaccination in Senegal—Successes, challenges, and lessons learned [Internet]. Vaccine. 2021. Available from: http://dx.doi.org/10.1016/j.vaccine.2021.08.042
3. Ardahan M, Temel AB. Visual Inspection With Acetic Acid in Cervical Cancer Screening. Cancer Nurs. 2011;34(2):158–63.
4. Lee H, Kang Y, Ju W. Cervical Cancer Screening in Developing Countries: Using Visual Inspection Methods. Clin J Oncol Nurs [Internet]. 2016 Feb;20(1):79–83. Available from: http://dx.doi.org/10.1188/16.CJON.79-83
5. Binagwaho A, Garcia PJ, Gueye B, Dykens JA, Simelela N, Torode J, et al. Eliminating Deaths From Cervical Cancer-Report of a Panel at the 7th Annual Symposium on Global Cancer Research, a Satellite Meeting at the Consortium of Universities for Global Health 10th Annual Meeting. J Glob Oncol [Internet]. 2019 Nov;5:1–7. Available from: http://dx.doi.org/10.1200/JGO.19.00287