facebook and the world

I am presenting a fascinating and visually stunning map which was created by a facebook intern named Paul Butler. He explains how this piece was generated: “I defined weights for each pair of cities as a function of the Euclidean distance between them and the number of friends between them. Then I plotted lines between the pairs by weight, so that pairs of cities with the most friendships between them were drawn on top of the others. “ You can read more on the topic here. The map shows that Russia and China are completely out of FB’s world, so it is most of Africa. In fact, Russia and China use some facebook clones, namely vkontakte.ru and renren, which are character friendly and provide, at least for China, government-friendly censorship of several key terms. Moreover, most of Africa and some parts of the southern American continent are not covered by the internet.

It is impressive that, at least in subsaharan Africa, the map does also illustrate the only countries where an efficient prevention of tumors is available. In fact, the prevention of cancer of the uterine cervix, breast and liver has been started only in South Africa, in Kenya -Tanzania, in Ghana - Nigeria, exactly where facebook lines are present in the map.  It seems fairly obvious that the pattern of diffusion of the internet in Africa (and facebook, as a consequence) reflects a higher level of civilization and a deeper consciousness of social health problems in those countries.

Salgado's afro-pessimism

Sebastiao Salgado is one of the most famous photojournalist in the world. Educated as an economist, he began his photography career in 1973 while traveling for work for the International coffee organization. Working entirely in a black and white format he has been able to construct penetrating images of the dispossessed peoples all over the world. He has a great respect for his subjects and always testifies to the fundamental dignity of all humanity while simultaneously protesting its violation by war, poverty and other injustices. He has published several books. One of them, Africa is an homage to the continent’s people and wildlife. The most impressive photos depict returning refugees, child soldiers, child portraits, rural workers, breathtaking pictures of Rwanda, hospitals, villages, etc. The majority of the pictures focus on what the text describes as “afro-pessimism”.  In fact, most of his pictures make you weep but this is done  with dignity and respect to the subjects in the photographs. Looking at Salgado’s work especially in this book is like being transported to another world, one that in many respects, and unfortunately, still exists. He has the ability to describe so many bad things making something beautiful out of it while, at the same time, not diminishing the suffering or the value of the subjects. Afro-pessimism is probably a feeling one cannot avoid when faced to the poverty, injustices, and human misery which are still so great and prominent sometimes in the life of African people. This blog is probably a little afro-pessimistic too but such a feeling, or attitude, is a positive one; in fact, talking about the problems serves as a stimulus to solve them. As many people as possible in the developed world should be invited to participate, to be part of the discussion, to get to know the real problems, to be truly concerned about what is going on in the underdeveloped world. Even a blog can help.

african american women and breast cancer

According to the Center of Environmental Oncology of the University of Pittsburgh Cancer Institute more African American women die of breast cancer than do white women.  This is probably due in part to racial disparities, higher exposure to environmental carcinogens, different lyfe style, and genetic factors. The US Centers for Disease Control and Prevention report that African American women with breast cancer fare worse than white women because they may have not access to quality health care or health insurance, or are often diagnosed with tumors that are more aggressive, or are exposed to toxic chemicals in a greater proportion at workplace. Although 1 in 8 Americans is African American, 1 in 3 houskeepers and blue collar workers, and 1 in 2 workers in sanitation jobs, are African American. The environmental risks of breast cancer include: cigarette smoking (including second-hand smoke); drinking more than two drinks of alcohol every day; obesity and being overweight especially after menopause; diets high in well done, smoked, preserved, fried or barbecued meats or fish, and diets low in fruits and vegetables. 

Relevant exposure to chemicals is found in polluted water and air, exhaust fumes from cars, trucks and buses, combustion products formed from burning wood chips, rubber, and when cooking meat or fish at high temperatures.  Workplace exposure to carcinogen chemicals occurs for dry cleaners, nurses, hairdressers, barbers, trucks/bus drivers. Personal risk factors associated with breast cancer include: family history of breast cancer; age older than 60; and use of hormone replacement therapy for more than a few months. 

What happens instead to African women? The rates of breast cancer seem much lower in most of Africa. Among regions, the age-standardized incidence rate is lowest in Central Africa (16.5/100,000) and highest in North America (99.4/100,000). The 5-year survival, however, is about 73 percent in industrialized countries, and 57 percent overall in developing countries. In summary, in low-income developing countries the incidence of breast cancer is lower than in the USA but the mortality rate is much higher. Accurate screening programmes to diagnose the tumor as early as possible represent the best tool to reduce breast cancer mortality but in most African countries they are still far from being implemented.

cellular phones and the risk of cancer: new insights.

Young mother speaking at her mobile phone, Hell Ville, Madagascar

There is an increasing concern in the  media  in the USA about the fact that long-term exposure to microwaves from cellular phones may lead to an increased risk of brain tumors, as well breast cancer and sperm reduction. Most of us have no idea that cell phones are small microwave radios that should not be kept directly on the body. Many researchers have demonstrated that the current standard of exposure to microwave during mobile phone use (cellular or cordless phones) is  not safe for long-term exposure. Although some studies have found no association, others suggest that the more hours of cellular phone use over time, the higher the risk of developing brain tumors. Risk also increases along with the level of power from the wireless device, years since first use, total exposure, and younger age when starting wireless phone use.
Cell phone’s microwave radiation seeps directly into soft fatty tissue of the breast and there already are some cases reported of breast cancer developed in close proximity to the site in the bra where cell phones are tucked and used for hours a day with a hands-free headset. For many young women today, tucking cell phones in the bra has become a cool, hip way to have simple access to these essential devices. As a way to get their newborn infant son to sleep through the night, some moms use i-Phone for the often-difficult task of pacifying them. They download several applications, including “BabySoothe” and “Lullabies”, and set them running throughout the night in close proximity to their baby’s head. Children’s brain (which double in size during the first year of life) is especially vulnerable to the emission of these two-way microwave radios, with their pulsed digital signals. Brains are not the only part of our anatomy that we need to be concerned about. According to several different studies, sperm count is 50% lower in men who use cell phones four hours a day—which is the case for a growing number of teenagers and young men.  Cells in human sperm exposed to cell phone radiation have been shown to die three times faster and become much sicker than those left alone. One may say that Africa is still free of this risk because of its poor economy and different lifestyle of inhabitant people. This is not completely true. I am not wrong if I believe that in most African countries, even the poorest, there is a widespread coverage by wireless communications facilities. These people may have no access to safe drinking water, or efficient health system, but, meanwhile, have no problem to use a cellular phone. The young mother shown in the photograph above, speaking at her mobile phone depicts this phenomenon: she lives in a country where prevention or early diagnosis of breast cancer or cervical cancer is not available but cellular phones are widespread among local people. Is the cellular phone lacking technologies to reduce exposure to microwave emissions an additional danger the developed countries are exporting to the low-income developing world ?.

Evita and the Pap smear

Evita Peron (Wikipedia)

Evita Duarte Peron, the wife of Juan Peron, the famous argentinian politician and statesman in the late 1940ies, died from aggressive, widespread cervical cancer at the age of 33, in 1952. At the time of her death, because of her genuine interest in the poor, she was greatly loved and respected by large numbers of the working class. When authorities announced her demise, the entire country went into mourning. After her death, thousands of people stood in line to view her body. 
The tumor must have been extremely aggressive, judging by the early age of onset and the rapid clinical course. On a first surgery, it was interpreted as an appendiceal carcinoma but the correct diagnosis was made one year later, on a second operation, when, probably, the tumor was not operable anymore.

Evita Perón had several risk factors that led to the eventual development of cervical cancer. Sexual activity presumably began at an early age. She married a man who had had multiple sexual partners. Even more important, Juan Perón's first wife, died from cervical cancer when she was only 28 years old. In addition, there was another possible risk factor; Evita's mother died of cervical cancer at age 77. We now know that infection with human papillomavirus (HPV), a common sexually transmitted disease, is the main cause of cervical cancer. Did Peron carry a particularly aggressive strain of HPV, the virus that we now know causes cervical cancer, and unknowingly transmit the infection to both his wives? 
What we do know today is that Evita’s death due to cervical cancer would likely never have happened if she had had a Pap smear in the due time.  The Pap smear was invented by George Papanicolaou in about 1920 and a regular screening based on pap smear examination was first started in 1939 at the New York Hospital. This diagnostic procedure was still unpracticed in Argentina in the late 1940ies otherwise Evita could have ben saved!

Dr. George Papanicolaou (Wikipedia)

How many women are nowadays, i.e. 70 years later, in the same situation as Evita's in most of the countries of the developing world where women do not have access to cervical cancer screening programmes?.

Suggested readings:

Lerner BH. The illness and death of Eva Perón: cancer, politics, and secrecy. The Lancet 2000;355(9219):1988-91.

Rodriguez AO. Curr.Opin.Obstet.Gynecol. Eva Perón: cervical cancer and the effect on a nation. 2009;21(1):1-3.

Fisher JW, Brundage SI. The challenge of eliminating cervical cancer in the United States: a story of politics, prudishness, and prevention. Women Health. 2009; 49 (2-3);246-261

Patterns of cancer in developed and developing countries

 

In other posts I have been talking about the differences in rankings between developed and developing (low- and middle-income) countries in both incidence and mortality for cancer. The patterns vary by geography and economic status, which correlate roughly with the causes of cancer in the "environment" in its broadest sense.
The majority of cancers in more developed countries are those associated with more affluent lyfestyles - cancers of the lung, colon and rectum, breast, and prostate. In contrast, cancers of the liver, stomach, esophagus, and cervix - all related directly or indirectly to infectious agents - are relatively more common in developing countries.  The mix of common cancer in females varies as seen in the following table (source: Cancer Control Opportunities in low- and middle-income countries; see website in the list). Click to enlarge:

In developed countries the incidence of tumors of the breast, colon, lung and corpus uteri is higher than in low- and middle-income countries with a ratio, respectively, of 1.23/1; 1.95/1; 1.02/1; and 2.19/1. The mortality of these malignancies, however, is lower than in developing countries: breast 29.8% vs. 42.8%; colon and rectum 49.3% vs. 60.0%; lung 82.5% vs. 86.5%; and corpus uteri 21.32% vs. 33.8%. The higher mortality of these tumors in the developing world is mainly due to a significant delay in the diagnosis of the disease, i.e. the tumor is disclosed in a more advanced stage of progression, when therapy is less effective or useless. Because of these factors, the number of people dying of breast cancer and lung cancer in developing countries is likely to be equal to or even higher than the number of subjects dying of these tumors in the developed world.
In developing countries the incidence of tumors of the cervix uteri, stomach, liver, and esophagus, is much higher than in developed countries with ratios, respectively, of 6.49/1; 1.86/1; 4.08/1, and 8.12/1. The higher incidence of these tumors is broadly explicable by differences in exposure to certain infectious agents (HPV, HBV, HIV, etc) or carcinogens, but it is also strongly related to the lack of primary prevention (vaccination against HPV and HBV), to an ineffective secondary prevention (i.e., screening of carcinoma of cervix uteri), and to the lack of health facilities for early diagnosis and treatment. In fact, it is very frustrating to realize that in developing countries a significant proportion of people dying for cancer were suffering from preventable and/or curable malignancies. It is for this reason that all efforts should be made by the global cancer community to take immediate steps to slow and ultimately reverse the phenomenon.

Ho avuto già occasione di parlare delle differenze in termini di incidenza e mortalità dei tumori nei paesi sviluppati in confronto con quelli in via di sviluppo. Tali differenze si articolano in base alla geografia e alle condizioni economiche e quindi, in generale, alle condizioni ambientali nel senso più largo del termine. In genere, nei paesi sviluppati l'incidenza più elevata di alcune forme tumorali  (carcinoma del polmone, colon e retto, mammella e prostata) è correlata agli stili di vita più seguiti. Nei paesi in via di sviluppo, invece, si osserva una maggiore incidenza dei tumori associati, direttamente o indirettamente, all'esposizione ad agenti infettivi (carcinoma del fegato, della cervice uterina, dello stomaco e dell'esofago). Tutte queste forme tumorali sono molto aggressive ad eccezione, almeno in parte, del carcinoma della cervice uterina. La variabilità di incidenza e mortalità nel sesso femminile sono ben illustrate nella tabella.
Nei paesi sviluppati l'incidenza del carcinoma della mammella, colon, polmone, corpo uterino, è più elevata che nei paesi in via di sviluppo in ragione, rispettivamente, di 1.23/1; 1.95/1; 1.02/1; e 2.19/1.  La mortalità di questi tumori, però, è meno elevata che nei paesi in via di sviluppo: mammella 29.8% vs. 42.8%; colon e retto 49.3% vs. 60.0%; polmone 82.5% vs. 86.5%; corpo uterino 21.32% vs. 33.8%. Tutto ciò è dovuto al ritardo con il quale viene identificata la malattia che preclude l'efficacia delle terapie perchè il tumore si trova in una fase più avanzata. Come diretta conseguenza, la mortalità almeno per cancro della mammella e del polmone è più elevata nei paesi in via di sviluppo anche se l'incidenza è inferiore rispetto ai paesi sviluppati.
Nei paesi in via di sviluppo l'incidenza del carcinoma della cervice uterina, dello stomaco, del fegato, e dell'esofago è molto superiore a quella che si riscontra nei paesi sviluppati, in ragione, rispettivamente, di 6.49/1; 1.86/1; 4.08/1, e 8.12/1. L'incidenza più elevata è riconducibile alla diversa esposizione ad agenti infettivi (HPV, HBV, HIV, ecc) o carcinogeni, ma anche alla totale mancanza di misure di prevenzione primaria (vaccinazioni anti HBV o HPV), o all'insufficienza di misure di prevenzione secondaria (p.es. lo screening per il carcinoma della cervice uterina) e, infine, alla mancanza di strutture sanitarie che consentano una diagnosi precoce con relativo trattamento. E' sconfortante pensare che nei paesi in via di sviluppo la maggioranza dei decessi per cancro sia correlata a tumori prevenibili o curabili se diagnosticati in tempo. Tutto ciò deve rappresentare per la comunità globale che si occupa di cancro un motivo per attivarsi in modo fattivo affinchè tale tendenza venga ridotta o addirittura invertita.

children in Sakatia and Nosy Be

This post is dedicated to the children we happened to meet in the last September while traveling by car on the roads of Nosy Be island or walking through the village in the island of Sakatia, Madagascar.




We were expecting to meet sad people, badly nourished and suffering, victims of a destiny which gave birth to them in one of the poorest countries of the world; and yet we will never be able to forget the hands tended for a contact, the smiles, the hearty welcome of most of them. At first glance one may easily perceive these villages as a community overrun by children. Children looked enthusiastic, curious, kind, joyful, inclined to interaction with us, always very decent.



Their mood was strikingly positive and it was a great pleasure to meet them. Adult men are practically missing, maybe because they are working far from the villages or even fishing on the sea or trading their goods. Women are actually present but still very few in number. They work hard and you often see them while carrying on their head incredibly large baskets.

These children and their families live in houses built out of ground, made up by only one or to the maximum two parts, where sleep sometimes eight, ten people. During a few days we shared their humble life by holding hands and laughing together without understanding each other but feeling the same emotions. These children and their parents need our help. Not only toys or our disused garments, but the chance of constructing theirselves their own life, and with the dignity they deserve.

Photos by Andrea Gherardi

how large is africa?

Just few words to focus on this stunning eye-opening image I found surfing on the net in the GOOD BLOG (see under the list of blogs on the column on the right side). Its author is Karl Krause.Click on it to see it enlarged. The image really puts the size of Africa into a whole new perspective. Its size is big enough to fit the United States, China, and much of Europe within its borders. Madagascar is as large as UK and Ireland combined. This just reminds us of how important it is to think about the millions of poor people who live there and the number of people in Africa who don't have access to "simple" things such as safe drinking water and health facilities.

Sign now for a cancer free world

The Union for International Cancer Control (UICC) is the leading international non-governmental organisation dedicated to the global prevention and control of cancer. It is set in Geneva, Switzerland, and was founded in 1933. UICC is the “custodian” of the World Cancer Declaration which is a call to action to substantially reduce the global cancer burden by 2020.The declaration was unanimously adopted at the World Leader’s Summit of policymakers, leaders & health experts during the 2008 World Cancer Congress in Geneva. The Declaration calls on the world to take immediate steps to reduce the global cancer burden and outlines 11 targets to be achieved by 2020. These include: 1) development of sustainable delivery systems to ensure that effective cancer control programmes are available in all countries; 2) improved measurement of the global cancer burden and the impact of cancer control interventions; 3) reduction of global tobacco consumption, obesity and alcohol intake levels; 4) effective widespread vaccination of populations in the areas affected by human papilloma virus (HPV) and hepatitis B virus (HBV); 5) improved public attitudes towards cancer by dispelling damaging myths and misconceptions about the disease; 6) improved diagnosis of many cancers when still localized through the provision of screening and early detection programmes; 7) increased access to accurate cancer diagnosis, 8) appropriate cancer treatments, supportive care, rehabilitation and palliative services for all patients worldwide; 9) increased access to effective pain control measures for all cancer patients in pain; 10) increased number of training opportunities available for health professionals in different aspects of cancer control; 11) achievement of major improvements in cancer survival rates in all countries. The declaration can be downloaded from the UICC website in different languages. Currently about 128000 people and 1035 organizations from all over the world have signed it. The reasons why everybody should do so are that cancer kills more people than AIDS, Malaria, and Tuberculosis combined, and the death toll is set to rise dramatically in the coming decades; two-thirds of cancer-related deaths occur in countries where resources available for cancer control are limited or nonexistent; without significant improvement, over 17 million people are projected to succumb from this disease by 2030; many cancers can be prevented, and several cancers can be cured if detected early and treated appropriately. This blog has been provided by a link to allow people to sign the Declaration (see the column on the right) . Let’s support such a call to action!

targeted therapies for advanced cancer or primary prevention of tumors: ethical and economical issues.

Targeted terapies have significantly changed the treatment of cancer over the past 10 years. These drugs are now a component of therapy for many common malignancies, including breast, colorectal, lung, and pancreatic cancers, as well as lymphoma, leukemia, and multiple myeloma. They are a sort of smart bombs designed to target the cancer cells and block or slow the growth of certain types of cancer minimising damage to healthy cells . Most of them, however, improve survival by only a few weeks or months but they don’t cure cancer.

Targeted therapies are incredibly expensive. For example multidrug colorectal cancer treatment regimens containing bevacizumab or cetuximab cost up to $30,790 for eight weeks. In the United States, sales of erlotinib, a drug which is able to prolong survival by few months in a selected fraction (no more than 20%) of lung cancer, totalled $457 million in 2008 (Annual report to shareholders, 2008. Genentech). This is the reason why their use is an opportunity and a threat to every system that simultaneously seeks to improve the health of its members or citizens and to work within ever-tightening budget constraints.

These considerations open additional ethical issues. It is better to invest on a minimal increase in time survival for a patient with highly advanced gastrointestinal or pulmonary cancer or, instead, on the primary prevention of some preventable tumors when this is feasible?. Carcinoma of the cervix uteri represents a good example of preventable tumor. There is, in fact, compelling evidence that vaccination against human papilloma virus (HPV) in young girls allows total prevention of the tumor. Gardasil, the HPV vaccine, is currently being offered for approximately $120 per single dose. Three doses are required over a 6-month period, making the total cost for the HPV vaccine about $360. With the same amount of money which is required to treat a patient with advanced colon cancer administering the above multidrug treatment regimen ($30,790) we could pay for a vaccination campaign against HPV for 87,500 girls (!). While the patient with colon cancer will eventually die, the above population of future women will be be totally protected from carcinoma of the cervix uteri. I am well aware that biotechnological research in pharmacogenomics should not be stopped because it will eventually provide, in the future, the magic drug to stop cancer. At the same time, however, money should be used also for people of the third world to cope the emerging epidemic of preventable tumors at least because this will impact beneficially the life of the whole planet.

Medical expedition to Sakatia and Nosy Be islands: a preliminary report

This is the story of an expedition recently conducted by three medical doctors including me, two anatomic pathologists and one general surgeon, supported by a young medical student, all from Milan, Italy, and volounteers of the Change onlus relief agency. The aim of the mission was to test the incidence of pap-smear cytological abnormalities in a restricted female population which had never been screened before for cervical cancer and is at a presumed high risk of developing this malignancy.

We brought from Milan all the stuff which is required to collect, smear, and stain cytological samples including a light microscope for immediate on site interpretation. Our goal was to work together with a team approach trying to conclude the procedure of screening, including the release of all cytological reports, on a same-day basis.

Fig. 1

Women had been invited in advance to be present for a clinical evaluation and pap smear sample collection in the days of September 14th, and 15th, 2010, at the Dispensaire of Sakatia (Fig 1), a first level health facility recently built up by Change onlus organization in that small island at just a 20 minutes boat ride from Nosy Be, and on September 16th, at the Infirmary facility of the Pecherie factory in Nosy Be island (see Fig. 2).

Fig 2

Fifty two women were seen in Sakatia and 42 women in the Pecherie Infirmary. The age ranged between16 to 57. Most of them were multiparous. After filling a questionnaire and providing her precise patient demographics, each woman underwent pelvic examination and pap smear sampling. Smears were then rapidly stained manually according to the Papanicolaou method (Figs 3 and 4).

Fig. 3

Fig. 4

Fig. 5

Microscopic evaluation followed on site and the pathological report was generated according to the Bethesda System, 2001, using a portable personal computer.

Women’s attitude to the gynecological work up was very good and they reacted enthusiastically to our initiative. Fig 6 shows a group of them chatting outside the Sakatia Dispensaire and waiting for their turn.

Fig 6

Results

Diagnosis (Bethesda)	Pecherie	Sakatia	Further work-up
HSIL	1	1	Colp+bp
AGC-neo	1	1	Colp+bp
LSIL	2	2	Colp+bp
ASCUS-HPV	1	3	Colp+ bp+ HPV test
ASCUS		1	P-smear repeat

Legend to the figure: colp = colposcopy; bp = biopsy; P= pap.

HSILs were detected in two women aged respectively 27 and 37, while the women diagnosed as having AGC-neo lesions were 43 and 47 years’ old. The incidence of High grade (HSIL and AGC-neo) and Low grade (LSIL, ASCUS-HPV, and ASCUS) lesions cumulatively reached values which are rather high according to WHO's estimates (see "Comprehensive Cervical Cancer Control. A guide to essential practice", p. 40, World Health Organization, 2006) for previously unscreened population:

SIL	Pecherie	Sakatia	WHO
High Grade	2 (4,76%)	2 (3,84%)	1-5%
Low Grade	3 (6,97%)	5 (9,61%)	3-10%

The 11 women who are candidates to further examination will be examined in November 2010 by a Gynecologist and colposcopist and the results of further tests, including biopsy and viral molecular tests, will be immediately reported on this blog.

Conclusion

Although the number of cases described in this report is fairly small, it is quite evident that women in Madagascar urgently need to be screened for uterine cervical cancer. Our effort will continue and we strongly hope that, under our guide and supervision, in few years the whole female population of the Nosy Be Island will be screened on the basis of a well organized plan and under the support of local Health authorities. We are deeply convinced that before starting to educate local health personnel and medical Doctors to the need of a well planned screening programme, and before teaching them to do theirselves, it is important to work hard locally as actively as possible to show the real advantages of it. In other words we still need to persuade them to the necessity of performing such screening procedure before trying to teach them how to do it. Our operative approach, consisting of a multidisciplinary team of physicians who intensively concentrated their efforts in few days, seems to be the best way to obtain such a result. In future expeditions also a Gynecologist will take part of the team with significant advantages in terms of speed of diagnosis and treatment. Doing first is, at least in this setting, much better than teaching first.

From left to right: Stefania Rossi, MD and MIAC, Anatomic Pathologist, San Paolo University Hospital, Milano; Sofia Bronzato, intern Medical Student at the San Raffaele University Hospital, Milano; Adolf, the local Nurse on duty of the Dispensaire of Sakatia; Franco Silva MD, General Surgeon and Interventional Radiologist, Fatebenefratelli Hospital, Milano; Liza, Translator and patient herself; Giorgio Gherardi, MD, Anatomic Pathologist and Head of Pathology, Fatebenefratelli Hospital, Milano, Italy. Photographs by Andrea Gherardi: website and blog

Cancer of the cervix uteri, a preventable tumor

Cancer of the cervix uteri is the second most common cancer among women worldwide. About 86% of the cases occur in developing countries. Every 10 minutes, a woman in Africa dies from cervical cancer, despite the fact that almost every case is preventable through a programme of screening, treatment and vaccination against the Human Papilloma Virus (HPV). In Madagascar it is the most commonly detected malignancy in females with an incidence >45 cases / 100000 inhabitants per year. According to the African Oxford Foundation "Globally there are over 500,000 new cases of cervical cancer annually and in excess of 270,000 deaths, accounting for 9% of female cancer deaths. 85% of cases occur in developing countries and in Africa Mortality rates vary seventeen fold between the different regions of the world. Cervical cancer contributes over 2.7 million years of life lost among women between the ages of 25 and 64 worldwide, some 2.4 million of which occur in developing areas and only 0.3 million in developed countries. Africa has 9 times the incidence of cervical cancer compared to the USA and 24 times the mortality. Cervical cancer incidence and mortality rates have declined substantially in Western countries following the introduction of screening programmes. Screening programmes in Africa, are however, often rudimentary or non-existent. The vast majority of women who suffer cervical cancer in Sub-Saharan Africa present with disease advanced far beyond the capacity of surgery or other treatment modalities to offer cure. Palliative care services are very poorly developed and therefore these unfortunate women are sentenced to a miserable end of life.