With concerted efforts, cervical cancer can be eliminated
Dr Margaret Njenga
Cervical cancer is preventable and curable, as long as it is detected early and managed effectively.
Yet it is the second most common cancer among females in Kenya, contributing 5,236 (12.4 per cent) of the new cancer cases annually and claiming more than 3,200 lives annually.
The World Health Organisation (WHO) defines cervical cancer elimination as reducing the number of cervical cancer cases to less than four cases per 100,000 women.
When this is achieved, cervical cancer will be ‘eliminated as a public health problem’.
For countries to be considered on the path towards elimination of cervical cancer as a public health problem must meet the WHO’s 90-70-90 targets by 2030.
The targets refer to: 90 per cent of girls fully vaccinated with the Human Papilloma Vaccine (HPV) by the age of 15; 70 per cent of women screened with a high-performance cervical cancer test by the age of 35 and 45; and 90 per cent of women identified with cervical disease receive treatment (90 per cent with pre-cancer treated; 90 per cent with invasive cancer managed).
Kenya introduced HPV vaccine into the routine immunisation programme in 2018, aiming to protect up to 800,000 girls over nine years annually.
Nearly all cervical cancers are caused by HPV infections. The most effective time to prevent the infection is in children before they become sexually active.
WHO recommends vaccination among girls between nine and 13 years, though the vaccine can be given into adulthood.
The vaccine provides safe, effective, and long-lasting protection and is given for free in public health facilities.
Concerted efforts are required to increase the uptake of the vaccine towards reaching the 90 per cent WHO target.
Cervical cancer burden can be reduced through early detection and management of pre-cancerous conditions.
While the Kenyan National Cancer Screening Guidelines recommend women aged 25 to 49 take up screening at least once in five years, only 16 per cent have taken up screening services in Kenya, a far cry from the recommended 70 per cent to put Kenya on its path to cervical cancer elimination.
Through use of simple and affordable technology, visual inspection with acetic acid, early cell changes can be detected and managed before they progress to cancer.
The survival rate is close to 100 per cent when pre-cancerous changes are found and treated making screening increasingly relevant and paramount in preventing cancer-related deaths.
Unfortunately, 70 to 80 per cent of cancer patients are diagnosed at an advanced stage.
Unless concerted efforts are put in place to prevent and control the disease, it is projected cervical cancer cases will rise to 7,057 per year with 4,869 (69 per cent) annual deaths by 2025.
Fortunately, various cervical cancer treatment options are available and the survival rate is higher if detected early.
Cervical cancer is one of the only cancers that can be prevented before it develops using either or both vaccination and screening.
It is known to take many years to advance from its pre-cancerous phase, therefore, efficiently using available screening options regularly and vaccination is critical towards accelerating progress towards cervical cancer elimination.
The high prevalence of cervical cancer in developing countries, Kenya included, is attributed to scarcity and inadequacy of screening programmes, economic constraints and knowledge deficits.
Additionally, where the services are available, women may not be aware of them and their importance and may, therefore, not bother to seek the services.
Investing in prevention and control now will not only improve health and save lives, it will also have a multiplier effect that can help countries advance other human and social development objectives for generations.
With the diverse actors working towards cervical health, from the National Cancer Institute of Kenya driving coordination at the national level and Tunza franchise clinics working to expand access to services, through to movements such as Kizazi Chetu broadening public awareness and conversation on cervical health, we can truly set the foundation for elimination of cervical cancer.
There is no single path to eliminating it, and, therefore, we must embrace various strategies and all partners brought on board to support the government towards fast-tracking the elimination of cervical cancer by 2030. - The writer is Chief Operating Officer, Population Services Kenya
