Jamaica at crossroads in cervical cancer fight

JAMAICA STANDS at a critical crossroads in the fight against cervical cancer, a largely preventable disease mostly caused by the human papillomavirus (HPV), which continues to take the lives of many women each year.

Despite advancements in screening, diagnosis and treatment, Jamaica is still lagging behind on global targets. This urgency was brought into sharp focus at the Dr Joseph St Elmo Hall Memorial Lecture, recently hosted by the Jamaica Cancer Society.

The annual symposium honours the life and work of Dr Joseph St Elmo Hall, a visionary in obstetrics and gynaecology who played a crucial role in establishing Jamaica’s early detection protocols and national cervical cancer-screening guidelines. His legacy of patient advocacy and medical education continues to inspire the country’s ongoing efforts to eliminate cervical cancer.

This year’s lecture, themed around cervical cancer prevention, brought together medical experts, policymakers, and advocates for a virtual symposium filled with insights and thought-provoking discussions.

Moderated by Dr Ian Bambury, the session featured Dr Loxley Christie presenting fertility preservation options; Dr Jamie Lee Foote detailing chemotherapy advancements; Dr Praveen Sharma highlighting radiotherapy for advanced cervical cancer; and Dr Pearnel Bell examining the intersection of mental health and cervical cancer care. Based on the robust discussions, there is a clear consensus that prevention, early detection, and holistic patient-centred care must go hand in hand.

At the heart of the lecture was a stark message delivered by Dr Anna-Kay Taylor Christmas in her presentation titled ‘Updates & Advances in Cervical Cancer: The Road to Elimination in Jamaica’. Her presentation framed Jamaica’s progress and urgent need for acceleration within the context of the World Health Organization’s (WHO) Cervical Cancer Elimination Initiative.

The WHO’s goals are clear: 90 per cent of girls fully vaccinated against HPV by age 15, 70 per cent of women screened using a high-performance test by age 35 and again at 45, and 90 per cent of women with cervical disease receiving treatment – all by 2030. Her call to action was unflinching: “If we fail to move swiftly, we will continue to lose lives to a disease that is both preventable and treatable.”

However, Jamaica is not yet on track, according to data presented by Dr Taylor Christmas. Jamaica’s HPV vaccination coverage in 2022 was four per cent, compared to 13.5 percent in Antigua and Barbuda, 22 per cent in Trinidad, and 83 per cent in Dominica (WHO, 2022). This is despite overwhelming evidence of the vaccine’s effectiveness in preventing cervical cancer, especially among girls age nine to 14. Misinformation, limited access, and vaccine hesitancy are barriers that we must address with urgency and unified public education.

Amid these sobering statistics, Dr Tamu Davidson, director of non-communicable diseases and injury prevention at the Ministry of Health and Wellness, underscored the impact of cancer during her presentation, ‘Updates on the Cervical Screening Guidelines’.

She emphasised that non-communicable diseases remain the leading cause of death and disability in Jamaica, accounting for 77 per cent of all deaths in 2020. Of these, cancers contributed to 23.7 per cent, with cervical cancer responsible for approximately five per cent of cancer-related deaths. Despite the gravity of the situation, there has been encouraging progress. New cervical cancer cases declined by 22.6 per cent from 486 in 2018 to 376 in 2022, while cervical cancer-related deaths dropped by 34.6 per cent, from 361 to 236 over the same period, showing improvements in incidence and mortality (Global Cancer Observatory, 2022).

One of the most promising advancements discussed at the Dr Joseph St Elmo Hall Memorial Lecture was the shift from cytology-based screening towards HPV testing, which is more accurate and sensitive. The results from a Canadian cervical screening trial revealed that the sensitivity of HPV testing was 94.6 per cent, compared to 55.4 per cent for conventional Pap smears (Mayrand et al, 2007). It is without any surprise that HPV testing is the recommended testing methodology by the WHO for cervical cancer screening.

New options like self-sampling kits, including the Teal Wand – a US Food and Drug Administration-approved at-home cervical cancer screening kit – urine-based tests, and AI-powered digital pathology have the potential to transform cervical cancer screening, particularly in low-resource settings. Yet, cost remains a major hurdle. HPV tests currently cost between $13,000 to $15,000 in private clinics, a barrier that cannot be ignored.

According to Roshane Reid-Koomson, executive director of the Jamaica Cancer Society, a critical but often overlooked part of this equation is the human resource infrastructure needed to support diagnostic services.

“There is a national shortage of cytologists, the specialists trained to examine cells for early signs of cancer. This shortage has led to Pap smear result delays of three months up to a year, well beyond the typical four weeks turnaround time. Such bottlenecks can mean the difference between early intervention and late-stage diagnosis. Without enough trained cytologists, even the most ambitious screening goals are likely to falter,” Reid-Koomson said.

Looking ahead, she said there are plans to link screening data through an electronic health records system that could streamline follow-up care and enhance coordination between labs, clinics, and health authorities.

“Currently, girls and women up to age 26 can receive the HPV vaccine free of charge at public clinics, and women age 21 and older are encouraged to begin routine cervical cancer screening,” she said.

This year’s Dr Joseph St Elmo Hall Memorial Lecture, she said, has made it clear that while Jamaica has made meaningful progress, the pace towards eliminating cervical cancer remains too slow. Vaccine hesitancy, limited access to screening, and systemic delays, she said, all continue to pose formidable barriers, but none are insurmountable.

“Now more than ever, we must strategically scale up cervical cancer prevention through national campaigns, school-based vaccine drives, workplace screenings, and stronger collaboration across government, civil society, and the private sector,” Reid-Koomson said.

Nevertheless, Reid-Koomson has commended UNICEF and the Ministry of Health and Wellness for its forward-thinking approach with the launch of the HPV chatbot at the HIV Adolescent Health Fair, held at Rudolph Elder Park in Morant Bay during Vaccination Week in the Americas. “This innovative tool represents the kind of bold, youth-centred intervention needed to bridge information gaps and engage the next generation in prevention efforts,” she said.

SOURCE: The Jamaica Cancer Society; Roshane Reid-Koomson, executive director of the Jamaica Cancer Society contributed to this story.