International Centre for Reproductive Health, Department of Public Health & Primary Care, Ghent University, C. Heymanslaan 10 UZ/ICRH, 9000, Ghent, Belgium.
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
BMC Int Health Hum Rights. 2020 Jul 31;20(1):21. doi: 10.1186/s12914-020-00237-9.
Cervical cancer claims 311,000 lives annually, and 90% of these deaths occur in low- and middle-income countries. Cervical cancer is a highly preventable and treatable disease, if detected through screening at an early stage. Governments have a responsibility to screen women for precancerous cervical lesions. Yet, national screening programmes overlook many poor women and those marginalised in society. Under-screened women (called hard-to-reach) experience a higher incidence of cervical cancer and elevated mortality rates compared to regularly-screened women. Such inequalities deprive hard-to-reach women of the full enjoyment of their right to sexual and reproductive health, as laid out in Article 12 of the International Covenant on Economic, Social and Cultural Rights and General Comment No. 22.
This article argues first for tailored and innovative national cervical cancer screening programmes (NCSP) grounded in human rights law, to close the disparity between women who are afforded screening and those who are not. Second, acknowledging socioeconomic disparities requires governments to adopt and refine universal cancer control through NCSPs aligned with human rights duties, including to reach all eligible women. Commonly reported- and chronically under-addressed- screening disparities relate to the availability of sufficient health facilities and human resources (example from Kenya), the physical accessibility of health services for rural and remote populations (example from Brazil), and the accessibility of information sensitive to cultural, ethnic, and linguistic barriers (example from Ecuador). Third, governments can adopt new technologies to overcome individual and structural barriers to cervical cancer screening. National cervical cancer screening programmes should tailor screening methods to under-screened women, bearing in mind that eliminating systemic discrimination may require committing greater resources to traditionally neglected groups.
Governments have human rights obligations to refocus screening policies and programmes on women who are disproportionately affected by discrimination that impairs their full enjoyment of the right to sexual and reproductive health. National cervical cancer screening programmes that keep the right to health principles (above) central will be able to expand screening among low-income, isolated and other marginalised populations, but also women in general, who, for a variety of reasons, do not visit healthcare providers for regular screenings.
宫颈癌每年导致 31.1 万人死亡，其中 90%发生在中低收入国家。如果在早期通过筛查发现，宫颈癌是一种高度可预防和可治疗的疾病。政府有责任为妇女筛查癌前宫颈病变。然而，国家筛查计划忽略了许多贫困妇女和社会边缘化的妇女。与定期接受筛查的妇女相比，未接受充分筛查的妇女（称为难以接触的妇女）宫颈癌发病率更高，死亡率更高。这种不平等使难以接触的妇女无法充分享有《经济、社会、文化权利国际公约》第十二条和第二十二号一般性意见所规定的性健康和生殖健康权利。
本文首先主张制定基于人权法的量身定制和创新的国家宫颈癌筛查方案（NCSP），以缩小获得筛查机会的妇女与未获得筛查机会的妇女之间的差距。其次，承认社会经济差距要求各国政府通过与人权义务相一致的 NCSP 采用和完善普遍癌症控制，包括覆盖所有符合条件的妇女。通常报告但长期得不到解决的筛查差距与以下方面有关：充足的卫生设施和人力资源的可用性（例如肯尼亚）、农村和偏远地区人口获得卫生服务的实际可及性（例如巴西），以及对文化、种族和语言障碍敏感的信息的可及性（例如厄瓜多尔）。第三，政府可以采用新技术来克服宫颈癌筛查的个人和结构性障碍。国家宫颈癌筛查方案应根据未充分接受筛查的妇女的情况调整筛查方法，牢记消除系统性歧视可能需要投入更多资源来关注传统上被忽视的群体。
政府有尊重人权的义务，重新将筛查政策和方案的重点放在受到歧视影响、无法充分享有性健康和生殖健康权利的妇女身上。以健康权原则（上述内容）为中心的国家宫颈癌筛查方案将能够扩大对低收入、孤立和其他边缘化群体的筛查，也将能够扩大对一般妇女的筛查，这些妇女出于各种原因没有定期到保健提供者处接受筛查。
