Screening, vaccination crìtical in wàr against cervical càncer

When Pamela Savai lost her husband in 2017, she did not know her time off to mourn him would have any side effects.

For her, she just wanted to mourn and eventually heal from the pain of losing the father of her children.

“During that period, I took a break from everything, including regular routines such as taking the yearly cancer screening tests I used to go for. For two years, I kept off that process because I felt I was not ready to go back to normal,” Savai narrates.

Then in 2019, during the Cervical Cancer Awareness Month in January, Savai felt she was ready to face the world and decided to go for screening.

After screening, the doctors discovered a considerable number of lesions, which doctors could not immediately determine if they were cancerous.

She was then directed to undergo a Pap-smear, a screening used to detect potential precancerous and cancerous traces in the cervix.

After the procedure and with inconclusive results, she was directed to undergo colposcopy, a medical procedure, which visually examines the female reproductive are,  including the cervix and vulva and enables detection and treatment of precancerous lesions early before they transform to cervical cancer.

But then the doctors directed that she undergoes biopsy, where small tissue from her cervix was removed and taken for further testing, which eventually confirmed that she indeed had cervical cancer, but at an early stage.

 “I count myself lucky, because the cancer was discovered at an early stage (Stage One). I do not know what would have happened if I had delayed for another year,” she adds.

She says with the early detection, she underwent surgery to remove the cancerous cells, which was not as costly as treating an advanced stage cancer.

Stage One of cancer does not need chemotherapy and radiotherapy as part of treatment, which are the costliest part of cancer treatment, since they are undertaken in sessions.

At the first stage, patients only undergo surgery and often radiation, which is used in killing cancer cells or combination of the two and in some cases.

Also, patients can undergo hormone therapy, depending on the type of cancer cells found and any risk factors.

Costly affair

Savai says two things saved her life one of them being an early diagnosis of the killer disease. She says screening saved her the agony of going through the entire process of treatment, which cost her an arm and leg.

Another thing that saved her was an organisation that came through and paid the initial expenses, such as colposcopy and biopsy tests, which are not covered by the national hospital insurance fund.

She says the national fund only caters for the treatment in public hospitals leaving out the most crucial part in the cancer cycle, which is the early screening and diagnosis.

“When a woman undergoes for screening and she is told to go for a Pap smear and the after-tests, the majority of them, especially those from poor families will definitely not go, because they cannot afford it. It is so expensive even for those who have money,” she says.

Discrimination and misconceptions

Savai also says she would have lost the fight if she had opted to go to a public hospital where queues of patients seeking cancer treatment are endless and some die while still waiting to be attended to.

Mary Muthoni, a community health volunteer says the burden of cervical cancer goes beyond just the high cost of treatment.

She says the stigma caused by myths and misconceptions about the disease makes most of patients shy away from seeking treatment.

“When a patient has cervical cancer, there is an odor that comes from their private parts. Some people will conclude that the odor is caused by having sex with multiple partners,” she says.

A study by National Cancer Institute, Kenya shows breast and cervical cancer continues to be the common type of cancer with 16 per cent and 13 per cent of all recorded cancer cases in 2021/22 being of these two types.

Nakuru, Machakos and Kiambu counties recorded the highest cases of cervical cancer while Samburu, Turkana and Wajir counties did not record any case of cervical cancer.

Doctor Ahmed Ogwell,the acting director at Africa Cancer Data and Statistics (CDC) believes the numbers of cancer patients are higher than reported and the numbers are expected to rise faster in the next 20 years.

“Numbers will double by 2040 if we do not act now. About 75 people die everyday from cancer and its likely to hit 150 in 2040. If we fail to take the conversation to the communities, it is very likely that we would fail to meet the Sustainable Development Goals (SDGs) 17,” he says.

Ogwell says some of the challenges that hinder the fight against cancer, include gaps in cancer policies and lack of cancer registries to keep record of cancer incidents, limited capacity and resources, high cost of treatment, as well as few well-trained cancer specialities, such as community health volunteers and oncologists.

Doctor Mary Nyangasi, the head of National Cancer Control Programme at the Ministry of Health says Kenya loses approximately nine women to cervical cancer every day.

She says it is a major cause of public concern and it is the leading cause of mortality among women in Kenya. “Premature mortalities mostly happen among women between 35 and 49 years old who have cervical cancer. We need to reduce the numbers by 30 per ent by 2030,” she says.

Nyangasi says the majority of women affected by the cancer menace are those from rural areas with low income and from poor families’ background who cannot afford the first tests as well as the sequent treatment.

Also, women with low levels of education are more vulnerable to getting cancer than their educated counterparts as they are less likely to be screened or vaccinated.

“The disparity is evident since counties with high levels of poverty and low levels of education have low screenings and women have to travel kilometres away to access these services. But there are counties which have these resources making it easy for women to be screened,” she adds.

Nyangasi says Kenya has embraced calls by the World Health Organisation (WHO) to eliminate cervical cancer through the 90-70-90 cervical cancer targets that need to be achieved by 2030.

Joint efforts by stakeholders

WHO calls for vaccination of 90 per cent of girls between nine to 14 years, screening 70 per cent of women between 35 and 49 years by 2030 and 90 per cent of those screened need to be treated in case they are found to have cancer.

On vaccination, already 61 per cent of the targeted aged group have taken the first dose, but only 31 per cent of them have undertaken the second dose.

She says the target to eliminate cervical cancer is a collective journey, which needs joint efforts from stakeholders, including government and its agencies and those in the private sector.

To meet the target, Dr Nyangasi says they have been building capacity for all health workers from all levels of hospitals, such as dispensaries across all counties to enable them offer screening services to women.

Nyangasi says the government is also negotiating on accessing a single dose of HPV vaccines and also introducing it for boys too.

Embu Governor Cecily Mbarire says to win the fight, there is need for re-evaluation of cancer and issues around it.

She says, one thing that both the public and private sector needs to do is to create awareness on the importance of screening for cancer. “As we create that awareness, we need to bring the resources for screening closer to the people, such as Level One and Two hospitals to make it easy for them. This will encourage them to seek these services unlike when the screening happens in a distanced facility,” she says.

Awareness on vaccination

She says counties may opt to have cancer screening alongside other reproductive services to make the screening almost mandatory, which will then curb late diagnosis of cervical cancer.

Mbarire further says there is also a need to educate communities in the rural areas on why young girls need to be vaccinated before they start engaging in sexual activities.

Human papillomavirus (HPV) vaccine has been one of the contentious subjects due to the myths and misconception around it, which has made parents reluctant to allow their daughters to get vaccinated. HPV is a group of over 200 related viruses, and two of these viruses are know to cause high and low risk cervical cancer.

In her capacity, as one of the female governors, Mbarire says she will champion for change of how cancer issues are handled at the Council of Governors (COG).

“At the COG, the majority of them are men and they may not have first-hand information on how dire the situation is. As such, I want to bring experts to come and educate them and have survivors tell their stories, “she says.

With this, governors will be able to increase their budgetary allocation towards purchasing of screening and treatment equipment and more resources towards women’s health. “I also want to engage the presidency on how serious this issue is and push for the National Health Insurance Fund (NHIF) to cater for screening and treatment. I believe these high-level engagements might result in changes and we will eventually save 3000 women who die daily from cervical cancer,” she notes.

 Dr Ogwell says African countries have strategies towards creating awareness,preventive measures and  reducing risks-factors. He says CDC Africa is committed to supporting the continent in strengthening the knowledge of their health workers including CHVs and equip them with the right tools in readiness for deployment to work in the community. “Countries including Kenya should embrace using domestic products. At the moment,everything used in cancer, such as products and even knowledge is imported. Let us work in using domestic resources like knowledge from our researches,facilities and all that,” he notes.