N° 156
16 December 2004 

Woman treated for early invasive cervical cancer in rural India,
allowing for continuous social and economical support to her 6-children family.


Cervix cancer is the second most common cancer in women worldwide. Unlike other cancers, cervix cancer can easily be prevented through screening and treatment of detected pre-cancerous lesions. It has thus the potential to be greatly reduced by a well-organized screening. This characteristic makes it one of the priority in the fight against cancer worldwide.

A huge burden on the most vulnerable: poor women in the developing world
Each year, 500,000 women learn that they have cervix cancer and 230,000 die from it. The vast majority of these women (80%) live in developing countries. It adds unnecessary suffering and has a strong economic impact on the most deprived, their families and their communities.
This huge inequality in health is even more striking when we know that well-implemented screening programmes can easily prevent cervical cancer, as demonstrated by the experience of some developed countries over the past 50 years.

Well organized screening programs are cost-effective also in low-resource settings
Further, multi-country studies have shown that, if well-organized and monitored, low-frequency cervical cancer screening programs are truly cost-effective in many low-ressource settings. Despite this fact, to date, very few effective screening programs exist in these settings. Most of existing programs only lead to a waste of already scarce resources. Says Dr Peter Boyle, Director of IARC: "Cervical cancer is undoubtedly a public health issue that can and needs to be remedied by building awareness, developing policies and implementing effective screening programs, recognizing that screening is just the first step in the management of a woman with cervix pathology."

From observation to methodology: bridging the know-do gap
Developing a global tool for Health Program Managers to reach effective implementation and thus reduce the disease burden was a huge undertaking. It required experience in a variety of regions and across many disciplines. The result is commensurate with the high expectations: this methodological tool is now universally endorsed by the highest health authorities. It gives an applicable and clear answer to a true public health issue that affects millions of women. "We must bridge the know-do gap for the benefit of women in low-resource countries and their families", Dr Boyle went on.

A unique Global Partnership

Partnership is the key
The Alliance for Cervical Cancer Prevention (ACCP) is a partnership involving five international health organizations: the WHO’s International Agency for Research on Cancer (IARC), Engenderhealth, JHPIEGO, PATH and the Pan-American Heath Organization (PAHO). For the last 5 years, this Alliance has worked in more than 50 countries on identifying, promoting and implementing effective safe and affordable cervical cancer prevention strategies in low-resource setting. This was made possible by a 50 million-dollar grant from the Bill & Melinda Gates Foundation.

A "How to" manual designed for Health Managers to set up and implement screening
The major outcome of this international effort is a tool that can be directly included by countries in their public health strategies in the field for implementation. "Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers" is a key output of ACCP’s work. This 300-page manual provides information to program managers on how to plan, establish, implement, strengthen and monitor cervical cancer prevention and treatment services, recognizing that various service delivery options are needed for different geographic and cultural settings and a range of resource levels.

A universal endorsement
Global health issues of this magnitude are a shared responsibility and require the concerted efforts of various international organizations with their diverse expertise. In recognition of this value, this manual has already been endorsed by the World Health Organization (Headquarters and Regional Office for Africa) and the International Network for Cancer and Treatment (INCTR). This pragmatic manual is not affected by political or commercial lobbying and presents the full spectrum of screening tests without favoring any of them.

Cervical cancer screening high on Global Health Agenda
In March 2005, for the first time in WHO’s history, a World Health Assembly resolution is going to be discussed to provide opportunity to reinforce comprehensive cancer policies and strategies among Member States. This is a crucial step at a time when effective programs do not exist in low-resources setting and when strategies are being reviewed in developed countries to maximize cost-effectiveness of existing screening programs. For this matter, this manual, together with 3 other IARC and WHO publications related to policy making or providers’ guidelines, will be very useful in providing a comprehensive resource package, based on current evidence, that encompasses policy, service delivery and clinical practice.

Paving the way for other public health interventions
More that a simple publication, this constitutes a unique example of a synergistic approach by various international agencies preparing a comprehensive strategy for cervical cancer prevention in the world. Such partnerships increase the potential to highlight cervical cancer as an important public health issue and enhance the global reach of the message and materials. The success of such a screening program is highly dependent on the widest possible dissemination to the country level, and this will be made possible thanks to free distribution of this manual to all interested parties, in three languages.

Facts & Figures
  • Burden of disease : 500,000 new cases, 230,000 deaths/year;
  • Cervix cancer is easily preventable;
  • Screening for cervix cancer can be cost-effective even in low-resource settings;
  • Most existing programs are ineffective, due to poor organization;
  • This Manual is the achievement of 5 years of experience in 50 countries;
  • It was endorsed by a unique partnership of 8 organizations with different fields of expertise and backgrounds;
  • It is planned for free worldwide dissemination in 3 languages.

For further details on the Manual, please inquire by e-mail to Dr Cédric Mahé, at .
You may download a .pdf version of the Manual from: ACCP_screen.pdf
More about ACCP at
For more general information, contact Dr Nicolas Gaudin, Chief, Communications (
If you wish your name to be removed from our press release e-mailing list, please write to

World Health Organization
International Agency for Research on Cancer

Organisation mondiale de la Santé
Centre international de Recherche sur le Cancer

150, cours Albert-Thomas 69372 Lyon Cedex 08 (France)
Telephone: 33 472 738 485     Facsimile: 33 472 738 311

Selected endorsements, in alphabetical order:

The WHO Regional Office for the Eastern Mediterranean is inviting its Member States to:
"Prioritize cervical cancer screening on the national agenda by stressing on establishing prevention programmes that include intense public education, information and cervical cancer awareness activities and to be an integral part of national cancer control programmes. Also, the Regional Office is urging countries to design and implement cost-effective services for screening and secure standard management for cervical cancer."
Dr Hussein Abdel-Razzak Al Gezairy, Regional Director
WHO Eastern Mediterranean Region

"The time is now to step up our global efforts to decrease the burden of cervical cancer where this disease takes the biggest toll. This manual 'Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers', provides a practical guide to assist in the implementation of prevention and early treatment programs, a much needed tool for those ready to make a serious effort to integrate a strategy into their health care system. EngenderHealth and the ACCP partnership remain committed to bringing solutions progressively closer to the situations where the need is greatest and the task the most difficult."
Dr Amy E. Pollack, President

"INCTR strongly endorses this excellent manual which provides a comprehensive tool that covers all aspects of the establishment of an effective cervical cancer prevention program.
Particularly valuable is its emphasis on how to develop a plan that takes into consideration local circumstances, maximizes available resources and pays due attention to cost effectiveness. This volume will play a vital role in bringing cervical cancer screening programs to those areas and populations where they are most needed."
Dr Ian Magrath, Director
International Network for Cancer Treatment and Research (INCTR)

"JHPIEGO, an Affiliate of Johns Hopkins University, is both pleased and proud to endorse "Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers", created by the joint efforts of the Alliance for Cervical Cancer Prevention. We are certain that this guide will significantly enhance the ability of program managers worldwide to implement more consistent and effective cervical cancer prevention programs."
Dr Leslie Mancuso, President and CEO

"Cervical Cancer accounts for a high percentage of cancer deaths in women in Latin America and the Caribbean – as high as 49.2 percent in Haiti, compared with 2.5 percent in North America. These high rates result from problems in access and quality of services. We have taken big steps in developing effective measures through our Cervical Cancer Prevention project in the Region. Now we must sustain this effort by advocating at the political level, technical, donor and community levels to ensure the inclusion of cervical cancer prevention on countries’ agendas. This Manual will help program managers in the Americas to better organize their current prevention activities."
Dr Mirta Roses, Director
Pan American Health Organization

"As coordinating agency of the Alliance for Cervical Cancer Prevention (ACCP), PATH is very pleased to join ACCP partners, WHO, and other agencies in launching, "Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers." This important new ACCP publication documents five years of experience in planning, implementing, and evaluating cervical cancer prevention programs in developing countries; this experience shows that cervical cancer prevention programs can be feasible, effective, and sustainable in a range of low-resource settings."
Dr Christopher J. Elias, President

"Developed countries in the Western Pacific Region have made great strides in the prevention of deaths from cervical cancer. Recent technologies bring effective screening programmes within the reach of developing countries, where this cancer kills thousands every year, especially among the poor. This manual, in turn, puts the new technologies within the reach of health system managers at all levels. This manual will save many lives if used properly. It is warmly welcomed in this Region."
Dr Shigeru Omi, Regional Director
WHO Western Pacific Region