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Cervical cancer is preventable, yet annual global incidence and mortality rates remain unacceptably high. In 2020, the World Health Organization (WHO) adopted the Global Strategy for cervical cancer elimination with a central goal of screening and treating women with cervical pre-cancer and cancer. Approximately 90% of cervical cancer cases occur in low- and middle-income countries (LMICs), particularly in sub-Saharan Africa, South-Eastern Asia, and Latin America, where there is a shortage of medical specialists trained to provide essential screening, diagnosis, and treatment services.
The International Gynecologic Cancer Society (IGCS) recognized this challenge and identified an opportunity to leverage its global community and resources to address this problem. Effective interventions require relevant curricula, strong grassroots relationships, and sustained institutional engagement. The IGCS Global Curriculum and Mentorship Program paved the way with the creation of the Global Gynecologic Oncology Fellowship training program for LMICs. It is now complemented by the development of a training program focused on cervical cancer prevention, including screening, early detection, and treatment of pre-invasive cervical lesions for medical providers.
The IGCS Preinvasive Certificate Program provides a framework for basic training in pre-invasive cervical disease management to enhance both clinical knowledge and skills for all healthcare providers regardless of setting. The target audience includes physicians such as gynecologic oncologists, gynecologists, family medicine physicians, primary care doctors, as well as nurse practitioners, physician assistants, nurses, and other healthcare providers involved in the prevention and treatment of cervical dysplasia and other human papillomavirus (HPV)-related diseases.
The program is delivered in four phases designed to enhance providers’ knowledge and skillsets for treating pre-invasive cervical disease. Phase 1 includes basic theory on HPV-associated cancers, HPV vaccination, and cervical pre-cancer screening and treatment methods. Phase 2 includes advanced theory on these same topics in preparation for Phase 3, an in-person competency assessment focused on colposcopy and treatment of pre-invasive cervical disease. There is a fourth phase that is not mandatory, but strongly recommended, where all candidates who have successfully obtained the certificate of completion are invited to establish their own Project ECHO (Extension for Community Healthcare Outcomes), a tele-mentoring platform for their local community/area, with the support of IGCS for continuing clinical practice.
As of December 31, 2023, the IGCS Preinvasive Certificate Program has engaged 408 participants from 88 countries. Of those, 151 participants from 53 countries have completed Phases 1 and 2. Countries with the highest number of participants enrolled include India (36), Kenya, (22), Nigeria (21), Ethiopia (19), and the United States (18) (Figure 1). To date, nine graduates of the program are serving as local mentors and have started training providers at their own sites.
The International Gynecologic Cancer Society (IGCS) Preinvasive Certificate Program has engaged 408 participants across 88 countries. India (36), Kenya, (22), Nigeria (21), Ethiopia (19), and the United States (18) have the highest numbers of participants.
The IGCS Preinvasive Certificate Program has therefore shown early success in engaging countries, nurturing local champions that will mentor other local doctors, thus creating a network of experts. When equipped with effective knowledge and skills training, the pre-invasive clinician plays an essential role on the path towards cervical cancer elimination. More information can be found at https://igcs.org/preinvasive-disease-certificate-program/.
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Acknowledgments
The authors would like to recognize Mary Eiken, CEO of the International Gynecologic Cancer Society (IGCS), for her development and support of the program; Susan Ralph, Program Manager of the IGCS, for her leadership and tireless organization and support; Drs Linus Chuang and Tom Randall for their leadership of the Global Gynecologic Oncology Fellowship Program and support of the pre-invasive program; Mr Mark Munsell for the development and support of the program’s REDCap database; Debbie Leopold for her support with figure design; and, lastly, the international and local mentors for their devotion to the pre-invasive training programs and to patient care, the speakers and volunteers of the program.
Footnotes
Twitter @drjoeng, @MilaPSalcedo
Contributors II-P and MPS are co-chairs of the International Gynecologic Cancer Society (IGCS) Preinvasive Certificate Program. KMS is the immediate past chair and JS-YN is current chair of the IGCS Global Curriculum and Mentorship Program. Manuscript writing: all authors. Final approval of the manuscript: all authors. Accountable for all aspects of the work: all authors.
Funding The IGCS Preinvasive Certificate Program is supported in part by the Women Global Cancer Initiative (TheWomen.org), the Bristol Myers Squibb Foundation and the Linus Chuang Family.
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Competing interests None declared.
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