The east, central, and southern regions of Africa have some of the highest incidence rates of cervical cancer in the world, making the area the epicenter of the disease. Incidence rates in Zambia are the second highest in the world. The Cervical Cancer Prevention Program in Zambia (CCPPZ) was established in 2006 to address the heavy burden of cervical cancer in the country and the region. CCPPZ is a unique collaboration between Zambian and United States partner institutions from the academic (University of Zambia- School of Medicine), research (Centre for Infectious Disease Research in Zambia), and governmental (Zambian Ministry of Health) sectors.
Due to the laboratory and human capacity requirements of Pap smear-based cervical cancer screening and the expense of HPV-based screening, the Zambian government chose to use VIA (visual inspection with acetic acid) as its primary form of cervical cancer screening for the public sector. Through CCPPZ’s training program, nurses are taught to prevent cervical cancer by first washing the cervix with table vinegar (dilute acetic acid), taking a photograph of the cervix using a digital camera, and then freezing pre-cancers with carbon dioxide or nitrous oxide gas. This approach to cervical cancer prevention is often referred to as screen-and-treat. Patients with complex cervical lesions are referred to the Gynecologic Cancer Prevention Unit on the campus of UTH, where they undergo a biopsy.
The innovative system that uses cervical photographs for patient education, magnification, clinical triage, documentation, consultation and quality assurance has been dubbed “electronic cervical cancer control” or eC3. eC3 is used in all 50 cervical cancer prevention clinics. Patients found to have invasive cervical cancer are staged and referred for appropriate treatment. All services are provided in government-operated facilities.
Our efficient and low-cost screen-and-treat model has been hailed as the best approach to cervical cancer prevention in Africa. Presently the program is located in all of Zambia’s ten provinces and is currently undergoing rapid expansion. Thousands of cervical cancers have been prevented and lives saved.