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According to an article on the GLOBOCAN statistics of incidence and mortality of cancers worldwide, “cervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women” (p. 231, Sung et al., 2021). Cervical cancer results from the growth of abnormal cells in the lining of the cervix. The two most preventative methods used to the reduce the number of cervical cancer diagnosis are immunisation against HPV and cervical screening tests. Regular screening tests can help detect cancer before symptoms appear, making it easier to treat and increases the chances of survival. Although successful screening programs exist in high-income countries like the UAE, disparities remain among certain populations. Specifically for women from lower socio-economic backgrounds and migrants identified as a subgroup with lower cervical screening uptake.

Our recent study found that Emirati and non-Emirati women in Ras Al Khaimah also have low participation rates with pap tests (38.3%) and cervical screening tests (29.7%). In 2018, the UAE Ministry of Health and Prevention reported that approximately 50% of women aged 25-64 participated in cervical cancer screenings. However, the participation rate varied significantly across different emirates, ranging from 16% to 70%.

Several barriers that prevent women’s access to screening services have been identified. The two main factors are individual factors and factors associated with healthcare providers and systems. For instance, one’s lack of knowledge about cervical cancer and screenings or feelings of shame and stigma about screenings are individual factors. Issues such as the physician’s lack of sensitivity and limited availability of pre-booked appointments and clinic hours are healthcare provider factors.

Current interventions

In the UAE, the Pap smear and HPV vaccine is available for sexually active women. For the Pap smear, it is recommended that women aged 25–49 are tested every three years and women aged 50–65 are tested every five years. The HPV vaccine is available to women aged 13–26 years. Despite availability, cervical screening rates in the UAE remain low – 13.9% for mammogram and 28.0% for Pap smear. Therefore, future recommendations are discussed below.

Future recommendations

Based on the findings of our recent study, several policy recommendations can be implemented to improve cervical cancer screening rates among women in Ras Al Khaimah.

1. Increased awareness about the importance of cervical cancer screening and its prevention methods. Health authorities should conduct targeted awareness and educational campaigns to educate women about the importance of cervical cancer screening, benefits of screening, how often it should be done, and where women can access screening services. The UAE government and non-profit organisations can work together to create events that offer health screenings and social activities.
   
   
2. Address misconception and cultural and religious barriers.

• Comprehensive educational programs should be provided to address certain misconceptions about cervical cancer. These programs should highlight that cervical cancer can affect anyone, regardless of sexual activity or moral character.
• Healthcare providers should receive cultural sensitivity training to provide care that respects their patients' religious and cultural beliefs. Public campaigns featuring healthcare professionals or survivor stories can help break down barriers surrounding stigma and fear associated with screening-related procedures.
• Community engagement is also crucial in breaking down cultural barriers. Local leaders, religious figures, and healthcare providers should collaborate to promote community awareness and encourage women to prioritise their health.

3. Target Emirati women from lower socio-economic backgrounds and expatriate women: These women are facing extra challenges in getting screened for cervical cancer due to language and cultural barriers. Targeted interventions are necessary to address these obstacles and cater to their specific needs. Further, the availability of resources in diverse languages will enhance screening participation rates.

4. Provide accessible and affordable screening services: Governments should ensure that cervical cancer screening services are accessible and affordable for all women, including those from low-income backgrounds, living in rural and remote areas. This can be achieved by providing free or low-cost screening services as well as setting up more regional screening centres or providing mobile clinics that can reach women in remote areas. 

The UAE has limited specialised units and trained surgeons for gynaecologic oncology, and therefore access to services is limited. To improve patient care, an increase in dedicated units and training is recommended.

5. Advance a national screening program. A national screening program can increase screening rates and reduce cervical cancer incidence. Advancement in the national screening program can be done by promoting healthy lifestyles, encouraging early detection, and ensuring equal access to health services. This type of program will be cost-effective in the long term for all residents in Ras Al Khaimah.

To conclude, a multilevel strategy is needed to combat cervical cancer in Ras Al Khaimah and the larger UAE. Cervical cancer diagnosis can be reduced by raising awareness, removing cultural obstacles, and offering easily accessible screening programs. The cornerstone of our joint battle against cervical cancer in Ras Al Khaimah and beyond continues to be early detection.

References:

Sung, H., Ferlay, J., Siegel, R.L., Laversanne, M., Soerjomatarum, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer Journal for Clinicians, 71(3), 209-249. https://doi.org/10.3322/caac.21660