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Subspecialties Oncology, Profession, Screening and monitoring

To Save the Lives of Our Women

When it comes to cervical cancer in European countries, lower rates of testing are associated with two factors: lower national income and lower education levels in women (see Figure 1). In countries such as Moldova, a nation affected by both, cervical cancer incidence and mortality rates are high and prevention is poor. This is especially apparent when compared with other European countries.

Figure 1. Proportion of women aged 30–49 years who reported receiving a cervical smear test by country and year. In Moldova, 70 percent were screened in 2013 compared with 95 percent in the United Kingdom (1).

The proportion of cervical cancers diagnosed at late stages in Moldova sits at 51 percent – particularly high relative to countries such as the United Kingdom, whose late-stage diagnoses are approximately 21 percent. Current estimates indicate that 480 Moldovan women are diagnosed with cervical cancer annually and 248 die from the disease (2).

The Royal College of Pathologists (RCPath) in London is one of several medical institutions that have played a leading part in supporting development of Moldova’s gynecological pathology service for cervical screening. An international collaboration to strengthen Moldovan pathology services began in 2016 between RCPath, the International Cervical Cancer Prevention Association (based in Belgium), the British Association for Cytopathology, the UK Institute of Biomedical Science, and the Italian Society of Pathology and Cytopathology.

Initially, two UK pathologists volunteered to visit Moldova to assess equipment and practices in several laboratories in the capital city, Chișinău, and in a regional laboratory (see Figures 2 and 3). From there, training needs were discussed and a plan was agreed.

Figure 2. RCPath scoping visit to Chișinău in 2016. This photo shows Moldovan pathologists, an interpreter (with handbag), and UK pathologists who were guided by Eugen Melnic (far right), President of the National Society of Pathology of the Republic of Moldova.

Two pathologists from Moldova were trained at Maidstone Hospital under the supervision of a consultant gynecological pathologist. Further training workshops were later held in Moldova in 2017 and 2018 to build the required capacity to implement the screening program. British histopathologists and a biomedical scientist contributed a curriculum, recommendations on lab service requirements, ongoing online training, and in-person training of 15 Moldovan pathologists.

Figure 3. Sample preparation for microscopic examination in a regional pathology laboratory.

Diana Valuta, head of the cervical cancer screening coordination unit in Moldova, commented at the start of 2022, “For 10 years, we have been fighting for the health of women in the Republic of Moldova. During these years, we have not been alone in our struggle and have been supported by many partners. I would like to thank the Ministry of Health of the Republic of Moldova, international organisations – especially the United Nations Population Fund (UNFPA) and the Swiss Agency for Development and Cooperation – civil society, the private sector, influencers and journalists, medical institutions, young volunteers and all those who have joined efforts to eliminate cervical cancer. We are different, but we fight for the same cause: to save the lives of our women.”

During Moldovan Cervical Cancer Prevention Week, held in January 2022, numerous calls to action encouraged proactive testing in women (see Figure 4). A 2020 survey showed that the knowledge of Moldovan women aged 25–61 about the screening test increased from 47 percent in 2018 to 62 percent in 2020 and the proportion of women receiving preventative testing doubled (3).

Figure 4. A poster used during Moldovan Cervical Cancer Prevention Week 2022 to promote the importance of preventative care during the pandemic. The text reads, “The health of women is important during the pandemic. Take the cytology test in safety.”

Adding to the push for greater awareness, there have also been significant achievements in the Moldovan health system, including the establishment of the Cervical Screening Implementation Coordination Unit and the National Reference Centre in Colposcopy. At the same time, medical specialists are being trained by British histopathologists and cytology laboratories have been endowed with updated equipment. Hedley Glencross, lead for cytology in Portsmouth and executive committee member of the British Association for Cytopathology, says that the next phase of the collaboration is to address laboratory quality aspects by means of reciprocal training visits between the UK and Moldova.

Over 760,000 Moldovan women aged 25–61 are expected to benefit from improved screening services. By 2025, the national incidence of cervical cancer is expected to decrease by 20 percent and mortality by 5 percent. Combined, HPV vaccination and regular cervical screening have the potential to reduce cervical cancer deaths by at least 80 percent.

Having been involved in the initial RCPath scoping visit to Chișinău in 2016, I am delighted to see this collaborative venture making further progress. I very much hope that these advances are not derailed by the ongoing pandemic, the refugee crisis, or the growing war in neighboring Ukraine.

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  1. J Williams et al., “Cervical cancer testing among women aged 30–49 years in the WHO European Region,” Eur J Public Health, 31, 884 (2021). PMID: 34491325.
  2. ICO/IARC, “Republic of Moldova: Human Papillomavirus and Related Cancers, Fact Sheet 2021” (2021). Available at: https://bit.ly/3MFgY2t.
  3. UNFPA Moldova, “Cervical Cancer Prevention Week celebrated for the 10th consecutive year in the Republic of Moldova” (2022). Available at: https://bit.ly/3MGOIfK.
About the Author
Charles van Heyningen

Charles van Heyningen is an International Advisor and Fellow of the Royal College of Pathologists, United Kingdom.

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