The World Health Organisation ranks Rwanda among the countries worldwide with the highest cervical cancer incidence, estimated at 49.4/100,000.This estimate is consistent with cervical cancer incidence in Eastern African at  is 42.7/100,000 women/year.In a bid to fight the disease, WHO issued guide notes for comprehensive cervical cancer prevention and control. According to the new guide notes, there is need for  primary prevention HPV vaccination, secondary prevention screening and treatment of precancerous lesions and tertiary prevention treatment of cervical cancer and palliative care.Dr Marleen Temmerman, from WHO, said recently during the Global Forum for Cervical Cancer prevention held in Malaysia that "HPV vaccination does not replace cervical cancer screening. In countries where HPV vaccine is introduced, screening programmes will need to be developed or strengthened.”According to Maurice Gatera, the Head of Vaccine Preventable Diseases Programme in the Ministry of Health, Rwanda is following the WHO approach. "Government has got to strategise to prevent cervical cancer; now the screening programme has started in some hospitals, vaccination of adolescent girls and cervical cancer screening in all districts hospitals,” he said.New cases Temmerman added that new cases of cervical cancer are diagnosed globally that need treatment. Invasive cervical cancer is treated by surgery and/or radiotherapy. Chemotherapy can complement the treatment regime in late stages. "In many countries there is insufficient capacity to provide these services or the existing services are not accessible and affordable to the majority of affected women,” he said.The guide notes indicate that cervical cancer is caused by sexually-acquired infection with Human papillomavirus (HPV). Most people are infected with HPV shortly after onset of sexual activity. Vaccination against HPV in girls 9 to 13 years old, combined with regular screening in women over age 30 for precancerous lesions followed by adequate treatment, are key tools to prevent the 530000 new cervical cancer cases diagnosed every year. Survival rates for cervical cancer can be further improved by establishing effective cancer treatment programmes.Given that the aim of a comprehensive cervical cancer prevention and control programme is to reduce the incidence of cervical cancer deaths, countries are advised to establish or improve reporting to cancer registries to monitor long-term trends in disease incidence and mortality rate.  Gatera said cervical cancer, the most common cancer among women in Rwanda, is an important national public health concern.Data from a population-based cancer registry in Butare (Huye) which functioned during the early 1990s showed cervical cancer responsible for 22.5 per cent  of cancers among women.  In a retrospective study of cancer cases from two university teaching hospitals (University Central Hospital of Kigali [CHUK] and University Central Hospital of Butare [CHUB]) seen from 2000 through 2004, cervical cancer accounted for 27.3 per cent of cancers among women and was the most common malignancy encountered in all age groupsAll girls or women above the HPV vaccination targeted age are advised to do screening at earlier age starting at 35 years.