Jakarta, February 22 2024
The Indonesian Ministry of Health (Kemenkes) supports the acceleration of the elimination of cervical cancer or better known as cervical cancer through the National Action Plan (RAN) which was launched last year. The RAN for the Elimination of Cervical Cancer contains four pillars, including the service pillar which includes screening, Human papillomavirus (HPV) vaccine immunization, and management for pre-cancer patients.
Cancer has become the highest cause of death both nationally and globally. WHO Regional Southeast Asia stated that Indonesia was ranked third highest in the region for incidence rate or number of new cases and fourth for mortality rate.
The International Agency for Research on Cancer (IARC) estimates that there will be 408,661 new cases and 242,988 deaths in Indonesia in 2022. In addition, IARC predicts a 77% increase in cancer cases in 2050.
Cervical cancer or better known as cervical cancer is a condition where the growth of malignant cells in the cervix/cervix is uncontrolled. Cervical cancer is caused by persistent infection with the oncogenic Human Papilloma Virus (HPV).
Based on its association with cervical cancer and precancerous lesions, HPV is grouped into high-risk and low-risk types. More than 75% of cervical cancer cases are caused by high-risk HPV types 16 and 18.
Head of the Ministry of Health’s PTM cancer and blood disorders work team, Dr. Sandra explained that WHO launched a Global Strategy for the Elimination of Cervical Cancer which targets the elimination of cancer by 2030. The global strategy contains targets 90-70-90, namely 90% of girls under the age of 15 years must receive HPV vaccination to prevent infection, 70% of girls 35 year olds and 45 year olds should be screened using high performance tests, and 90% of women with precancerous lesions receive standard treatment.
“In order to support the acceleration of global cervical cancer elimination, in 2023 Indonesia has prepared a National Action Plan (RAN) to eliminate cervical cancer. “We are making a national action plan to eliminate cervical cancer which is even more advanced than what WHO requested,” said Dr. Sandra which was conveyed at a media meeting via Zoom Meeting on Thursday (22/2/2024).
This NAP consists of four pillars. Pillar 1 of service delivery contains vaccination, screening and management activities. Pillar 2 education, training and counseling contains activities to strengthen health workers and public awareness. Pillar 3 driving progress contains monitoring, evaluation, research and digital support activities (digital enablers). Pillar 4 management and organization contains governance and policy activities, financing for elimination, collaboration and inter-sector partnerships.
For pillar 1, the RAN already contains targets for vaccination, screening and management. The Ministry of Health will carry out vaccination, screening and management in two phases, namely phase 1 in 2023-2027 and phase 2 in 2028-2030.
In phase 1 vaccination, the Ministry of Health is targeting 90% of girls aged 11 and 12 years in grades 5 and 6 or equivalent, including those not in school, to receive the complete vaccine. In this phase, the Ministry of Health is also targeting girls aged 15 years who have not received vaccination to receive further vaccination.
In phase 2, 90% of girls and boys aged 11 and 12 years should receive full vaccination. Apart from that, the Ministry of Health will also carry out further vaccinations for those aged 15 years and all adult women aged over 21-26 years according to request and need.
“For ages 21 to 26, we will ask them to be independent, so they will not enter the national program but the independent program. “We will encourage those who want and need to get vaccinated,” said Dr. Sandra.
For the first phase of screening, the Ministry of Health is targeting 70% of women aged 30 to 69 years to be screened using the HPV DNA test. Meanwhile, in the second phase, the Ministry of Health is targeting 75% of women aged between 30 and 69 years to undergo screening every 10 years. The main method of screening in these two phases will use the HPV DNA test.
“For screening, we will screen all (women) aged 30 to 69 who have not been screened using the HPV DNA test and co-testing with IVA. “The HPV examination uses an inspection (tool) so that at the same time we see, we also do IVA, we also get precancerous lesions because precancerous lesions are also part of getting early detection,” continued Dr. Sandra.
In screening, cotesting is also carried out, namely two types of tests simultaneously. In addition to the HPV DNA test, the Ministry of Health will carry out a Visual Inspection with Acetic Acid (IVA) examination to help identify cell changes in the cervix.
This cotesting is possible because HPV screening is carried out using a tool called inspeculo so that doctors can take tissue samples for HPV testing. Through this process, the doctor can not only take samples, but also observe directly to use IVA to look for signs or pre-cancerous lesions on the cervix.
This screening fulfills the goal of early detection of HPV infections and precancerous lesions. This allows early detection and timely treatment to increase the chances of recovery.
For management, the Ministry of Health provides timely and comprehensive treatment pathways for women with precancerous lesions or women diagnosed with cervical cancer so that they have access to quality treatment and care.
Chairman of the Indonesian Oncology Association, Dr. Dr. Brahmin Askandar, who was also a resource person at the media meeting, said that WHO said 30-50% of cancers could be prevented, especially those caused by infections.
“One example is cervical cancer which is caused by infection because cervical cancer is clearly caused by the HPV virus,” said Dr. Dr. Brahmin.
Dr. Dr. Brahmin continued, 90% of cervixes infected with high-risk HPV can actually be eliminated through treatment. However, HPV that is not detected and eliminated slowly becomes cancer and is called pre-cancer. Pre-cancer may or may not cause complaints.
“This is the importance of routine screening for women. Whether or not there are complaints, routine screening is required, especially for those who are sexually active. Why do you need routine screening? “Our aim is to do routine screening to catch changes in the cervix and not cause cervical cancer,” continued Dr. Dr. Brahmin.
The importance of screening for women is so that when the doctor finds an abnormal case of the cervix during screening, the patient can be treated immediately. Next, the patient receives simple measures to help him recover 100%.
Shanty Eka, who is a cervical cancer survivor and member of the CISC cancer community, shared her journey of recovering from cancer after going through a difficult time with excruciating pain. The healing process was carried out using surgery, therapy, 25 external radiation and three internal radiation. He hopes that the cervical cancer elimination program will help all Indonesian women avoid dangerous cervical cancer.
“With the cervical cancer elimination program, I really want all women in Indonesia to get vaccinated so that no Indonesian women get cervical cancer,” said Shanty hopefully.
This news was broadcast by the Communications and Public Services Bureau, Indonesian Ministry of Health. For further information, please contact the Halo Ministry of Health hotline number via hotline number 1500-567, SMS 081281562620 and email address [email protected] (DJ).
Head of the Communications and Public Services Bureau
Dr. Siti Nadia Tarmizi, M. Epid
2024-02-22 23:50:50
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