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Cervical cancer in Ethiopia: a review of the literature

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Abstract

Background

Cervical cancer is one of the most common malignancies affecting women worldwide with large geographic variations in prevalence and mortality rates. It is one of the leading causes of cancer-related deaths in Ethiopia, where vaccination and screening are less implemented. However, there is a scarcity of literature in the field. Therefore, the objective of this review was to describe current developments in cervical cancer in the Ethiopian context. The main topics presented were the burden of cervical cancer, knowledge of women about the disease, the genotype distribution of Human papillomavirus (HPV), vaccination, and screening practices in Ethiopia.

Methods

Published literature in the English language on the above topics until May 2021 were retrieved from PubMed/Medline, SCOPUS, Google Scholar, and the Google database using relevant searching terms. Combinations of the following terms were considered to retrieve literature; < Cervical cancer, uterine cervical neoplasms, papillomavirus infections, papillomavirus vaccines, knowledge about cervical cancer, genotype distribution of HPV and Ethiopia > . The main findings were described thematically.

Results

Cervical cancer is the second most common and the second most deadly cancer in Ethiopia, The incidence and prevalence of the disease is increasing from time to time because of the growth and aging of the population, as well as an increasing prevalence of well-established risk factors. Knowledge and awareness about cervical cancer is quite poor among Ethiopian women. According to a recent report (2021), the prevalence of previous screening practices among Ethiopian women was at 14%. Although HPV 16 is constantly reported as the common genotype identified from different grade cervical lesions in Ethiopia, studies reported different HPV genotype distributions across the country. According to a recent finding, the most common HPV types identified from cervical lesions in the country were HPV-16, HPV-52, HPV-35, HPV-18, and HPV-56. Ethiopia started vaccinating school girls using Gardasil-4™ in 2018 although the coverage is insignificant. Recently emerging reports are in favor of gender-neutral vaccination strategies with moderate coverage that was found superior and would rapidly eradicate high-risk HPVs than vaccinating only girls.

Conclusions

Cervical cancer continues to be a major public health problem affecting thousands of women in Ethiopia. As the disease is purely preventable, classic cervical cancer prevention strategies that include HPV vaccination using a broad genotype coverage, screening using a high precision test, and treating cervical precancerous lesions in the earliest possible time could prevent most cervical cancer cases in Ethiopia. The provision of a focused health education supported by educational materials would increase the knowledge of women about cervical cancer in general and the uptake of cervical cancer prevention and screening services in particular.

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Fig. 1

Adopted from WHO (Guidelines for screening and treatment of precancerous lesions for cervical cancer prevention, 2013). Program managers and decision-makers can start at the top and answer the questions accordingly to determine which screen-and-treat option is best in the context where it will be implemented. It highlights choices related to resources, which can include costs, staff and training

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Data availability

All the generated data are included in the manuscript.

Abbreviations

CIN:

Cervical intraepithelial neoplasia

HPV:

Human papillomavirus

IARC:

International agency for research on cancer

STD:

Sexually transmitted disease

VIA:

Visual inspection of the cervix with acetic acid

WHO:

World health organization

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Acknowledgments

We would like to thank Bahir Dar and Addis Ababa Universities and CDT-Africa for the provided opportunity to undertake this review.

Funding

We received no funds for this particular review.

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Authors and Affiliations

  1. Department of Medical Microbiology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia

    Awoke Derbie & Daniel Mekonnen

  2. Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia

    Awoke Derbie & Yimtubezinash Woldeamanuel

  3. Department of Health Biotechnology, Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia

    Awoke Derbie & Daniel Mekonnen

  4. Department of Medical Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

    Awoke Derbie, Yimtubezinash Woldeamanuel & Tamrat Abebe

  5. Department of Biology, College of Science, Bahir Dar University, Bahir Dar, Ethiopia

    Endalkachew Nibret

  6. Department of Gynecology and Obstetrics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia

    Eyaya Misgan

  7. Department of Diagnostics, Institute of Virology, Leipzig University Hospital, Leipzig, Germany

    Melanie Maier

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Contributions

AD and TA conceived the review topic and objectives. AD, DM and EM participated in the study selection and write-up. EN, MM, YW and TA reviewed the manuscript critically for its scientific content. All authors reviewed and approved the manuscript.

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Correspondence to Awoke Derbie.

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Derbie, A., Mekonnen, D., Nibret, E. et al. Cervical cancer in Ethiopia: a review of the literature. Cancer Causes Control 34, 1–11 (2023). https://doi.org/10.1007/s10552-022-01638-y

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