Recommendations of the APEC Regional Workshop on Enabling Sustainable Economic Advancement for Women through HPV and Cervical Cancer Prevention and Control

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Overarching Aim
To develop evidence-based policy recommendations and tools for APEC economies whose implementation of interventions at national and regional levels will prompt significant
reductions in cervical cancer and pre-cancer.

Recommendations for APEC Economies
1. Prioritize cervical cancer prevention and control by setting measurable targets for reduction of cervical cancer incidence and mortality and establishing evidence-based
programs to meet those targets
2. Improve public education and communication with regard to HPV vaccination and cervical cancer screening to support increased uptake of cervical cancer prevention and
control measures and reduce stigma.
3. Build national consensus and support for cervical cancer prevention and control programs

Recommendations for Primary Prevention
 Adopt and implement HPV vaccination for primary prevention of cervical cancer.
• Articulate and remove barriers to the inclusion of HPV vaccine to the national list of recommended vaccines, including addressing such issues as total cost of the
immunization program, financing, implementation strategy, and education needed to improve understanding and acceptance of HPV vaccination among health care
providers, educators, parents, and children.
• Recognize the need for the dual approach (vaccination and screening) in prevention, reaching girls unexposed to HPV and women already HPV infected.
• Balance resources for HPV vaccination coverage and cervical neoplasia screening.
• Identify factors that encourage or impede implementation of best practices, and modify existing policies and practices.

Recommendations for Secondary Prevention
• Incorporate the following key components in organized cancer screening programs:
– An understanding of communities and their needs (e.g. disease burden, public perception of the disease, social and cultural practices, health system and infrastructure)
– Ensure the availability of organized treatment services and include cervical cancer as a standard component of women’s health exams.
– Ensure counselling before screening
– Ensure appropriate and timely follow-up of women after screening
– Ensure quality assurance and control in each step of service delivery through supervision and evaluation
– Evaluate and improve single visit and point of care screening approaches where these may be the most feasible based on resources

Recommendations for Early Detection, Diagnosis, Follow-up, Treatment,
and Aftercare
• Ensure linkage of screening programs to treatment services.
• Identify and develop components in health systems that require strengthening in order to implement cervical cancer early detection, diagnosis, follow-up, and organized treatment programs with high coverage.
• Identify strategies, including use of technologies for cervical cancer screening and follow-up that can be implemented with high coverage in individual economies.
• Articulate and remove barriers to developing and implementing effective, affordable, and equitable cervical cancer early detection, diagnosis, follow-up, and treatment services in the existing health care system.
• Leverage existing programs developed for infectious diseases and women’s health.
• Develop organized registries (tracking system or clinical surveillance system) of cervical cancer screening for evaluation.

Recommendations for the APEC Life Sciences Innovation Forum and APEC Health Working Group
• Raise awareness of the negative economic impact of cervical cancer morbidity and mortality on women, families, and communities in APEC economies, enhance surveillance to better characterize the costs and burden of cervical cancer, identify and adopt policies and programs to mitigate negative economic impact.
•  Identify health systems and components in APEC economies that require strengthening, building on existing infrastructure for infectious disease and women’s health; identify components of such infrastructure that could be adapted to enhance strategies and systems to address the control of other cancers and non-communicable diseases.
•  Reach consensus among APEC economies to collect, monitor, evaluate, and share information on measurable outcomes and indicators, in order to accelerate acquisition of knowledge through cooperation among APEC economies.
  Identify ways to incorporate cervical cancer prevention and control programs into workplace health and wellness programs and community-based outreach programs, and to achieve high coverage of women in all programs.
•  Facilitate the development of a Road Map that includes an action plan specifying initiatives and steps towards coordinated action among partners within each APEC economy and among economies, and to establish follow-up plans for economies to
encourage and be accountable to one another in implementing the action plan.
•  Encourage collaborations among APEC economies, by providing a platform for multisector collaboration to support initiatives to enhance prevention and implementation and scale-up of effective, affordable and equitable cervical cancer prevention programs. Examples include supporting regional workshops and encouraging scientific research on key questions.
•  Foster dialogue on cost-effective strategies, best practices, and innovative measures to address cervical cancer in resource-limited settings.
•  Continue to support cervical cancer prevention and control as a key element of the Healthy Women/Healthy Economies initiative, which is designed to increase the number of women entering, remaining, and rising in the workforce through better
health.
•  Establish an APEC network to share information across all APEC economies, agree on regional goals and assessments to achieve measurable impact on women and economies from a reduction in or elimination of the pressure of cervical cancer.

Additional Actions That Could Be Taken by Economies Independent of APEC to Help Support Cervical Cancer Prevention and Control
•  Cooperate regionally to collectively negotiate affordable vaccines, tests, reagents, equipment, and training.
•  Support the Global Access Movement to improve global access to HPV diagnostics and vaccines, encourage and encourage companies to sign-on to the Global Access Agreement.

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