Cervical Cancer: The African perspective

Sub-Saharan Africa records the highest number of cases and deaths of cervical cancer annually making cervical cancer one of the biggest threats to African women.

What is cervical cancer?

Cervical cancer is a type of cancer that occurs in the cells of the cervix which is located at the lower part of the uterus that connects to the vagina. Cervical cancer is caused by a sexually transmissible virus called the Human Papilloma Virus (HPV). There are about 100 different strains of HPV that can be classified as either high risk or low risk strain. The high risk strains are associated with an increased risk of developing cancer; examples of these include HPV-16 and HPV-18. Almost 50% of sexually active adults will become infected with HPV during their lifetime. Most strains of the virus are low risk type and have minimal impact of hosts with healthy immune systems. Some of the high risk factors associated with cervical cancer development include having multiple sexual partners, early sexual activity, a weakened immune system, smoking, long term use of birth control pills, and exposure to miscarriage prevention drug (diethylstilbestrol). Early stage cervical cancer can be asymptomatic but shows symptoms at advanced stages. Symptoms may include watery or bloody vaginal discharge with a foul odour, pelvic pain or pain during intercourse, vaginal bleeding after intercourse, between periods or after menopause, needing to urinate more often, pain during urination. Cervical cancer can be treated in various ways depending on the type and stage of disease. Treatments include surgery, radiation therapy, chemotherapy and targeted therapy. One can reduce her risk of cervical cancer through regular screening tests and early vaccination.  

The burden of cervical cancer in Africa

Globally, cervical cancer is the third most common malignancy among women. According to the World Health Organization, 19 of the top 20 countries with the highest cervical cancer burden are in Sub-Saharan Africa. This means that Sub-Saharan Africa records the highest number of cases and deaths of cervical cancer annually making cervical cancer one of the biggest threats to African women. This could be attributed to poor access to education, screening and treatment on the continent.

Screening and vaccination

Cervical cancer is one of the most preventable and curable cancer if diagnosed and treated early. The World Health Organisation (WHO) recommends cervical screening for women aged 30 to 49 years to spot early signs of the cervical cancer where at this stage it is highly curable. There are several ways or tests used for cervical screening processes. Some of these tests include Pap smear test that detects changes in the cells of the cervix (abnormal cells). This test is generally recommended for people who are between 21-65 years and repeated after every three years. The HPV test on the other hand looks for the virus that can cause changes in the cells of the cervix. Some of the benefits of cervical screening include finding abnormal cell changes before symptoms develop and when these changes are easier to treat, finding HPV before it causes abnormal cells in the cervix and also this process tend to save lots of lives. Moreover, there are effective vaccines that protect women against the high-risk HPV type infection leading to the prevention of cervical cancer. Two doses of the HPV vaccine is offered to children between the ages of 11 to 12 years at 6 to 12 months apart of the first to receiving the second dose. The vaccination can also be started as early as 9 years and as old as 26 years. Some adults who are 27 to 45 years can also be vaccinated but this might not be beneficial if they have already been exposed to HPV. HPV vaccines have the potential to prevent more than 90% of HPV attributable cancers.  

Resources

Several African countries (Ethiopia, Kenya, South Africa, Botswana, Tanzania, Zimbabwe, Mozambique, Malawi, Zambia etc.) are introducing national programme for HPV vaccination. Find out more about HPV vaccine in your country below;

South Africa

https://www.spotlightnsp.co.za/2021/11/24/hpv-what-is-happening-with-sas-other-relatively-new-vaccine-programme/

Ethiopia

https://www.afro.who.int/countries/ethiopia/news/ethiopia-vaccinate-over-18-million-girls-against-human-papillomavirus-part-drive-prevent-cervical

Kenya

https://www.afro.who.int/news/kenya-takes-vital-step-against-cervical-cancer-and-introduces-hpv-vaccine-routine-0

Malawi

https://www.afro.who.int/news/malawi-track-towards-national-roll-out-cervical-cancer-prevention-through-hpv-vaccination

Tanzania

https://www.afro.who.int/news/tanzania-rolls-out-vaccination-against-cervical-cancer

Zambia

https://www.afro.who.int/news/human-papilloma-virus-hpv-vaccine-introduced-zambia

Below are useful links to learn more about cervical cancer screening in Ghana:

 https://holisticphysicianmd.com/ghana-health-resources/cervical-cancer-screening-ghana-2/

https://m.facebook.com/joy997fm/photos/cervical-cancer-prevention-screening-centres-in-ghanawhere-can-i-get-screened-co/10157864626181894/

https://www.mariestopes.org.gh/services/sexual-and-reproductive-health-services/cervical-cancer-screening-and-treatment/

https://www.yemaachi.com/sheba/ 

Links to US and UK cervical cancer vaccination programmes:

https://vk.ovg.ox.ac.uk/vk/hpv-vaccine#:~:text=The%20HPV%20vaccine%20is%20provided,5%25%20of%20all%20cancers%20worldwide 

https://www.kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in-the-u-s/#:~:text=Since%202017%2C%20Gardasil%C2%AE9,was%20approved%20by%20the%20FDA 

REFERENCES

https://www.healthline.com/health/sexually-transmitted-diseases/hpv-types

https://www.allaboutwomenmd.com/knowledge-center/understanding-hpv.html

https://www.healthline.com/health/cervical-cancer

https://www.cdc.gov/cancer/cervical/basic_info/risk_factors.htm

https://www.mayoclinic.org/tests-procedures/pap-smear/about/pac-20394841#:~:text=A%20Pap%20smear%2C%20also%20called,greater%20chance%20at%20a%20cure.

https://www.cdc.gov/cancer/cervical/basic_info/screening.htm

https://www2.hse.ie/screening-and-vaccinations/cervical-screening/why-cervical-screening-is-important/benefits-and-limitations.html

https://www.cdc.gov/vaccines/vpd/hpv/public/index.html#:~:text=HPV%20vaccination%20is%20recommended%20at,cause%20cancer%20later%20in%20life.