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Making quality cervical cancer prevention accessible

Dr David Parirenyatwa

The Zimbabwe National Cervical Cancer Control and Prevention Strategy (ZCCCPS) (2017-2020) was launched by Minister of Health and Child Care, Dr David Parirenyatwa, at the Gweru Provincial Hospital recently.
The ZCCCPS is an effort to combat the fourth most common cancer among women accounting for approximately half a million new cases per year globally and is a major cause of death.
Often, it is detected when it is too late to be cured resulting in the deaths of women mostly in the prime of their lives. The strategy’s objectives, are to ensure that eligible women have access to quality and affordable cervical cancer prevention and treatment services in order to reduce the incidence, prevalence, morbidity and mortality from cervical cancer and to improve the quality of life of cervical cancer patients.

It also intends to reduce the incidence and mortality rate of cervical cancer patients by reducing human papillomavirus (HPV) infections, detecting and treating cervical pre-cancer lesions, and providing timely treatment and palliative care for invasive cancer.
The ZCCCPS is expected to address gaps in cancer prevention and control including cervical cancer among other cancers. In 2012, 528 000 new cases of cervical cancer occurred globally and about 85 percent of these occurred in less developed regions.

In the same year, 266 000 women died of cervical cancer worldwide and almost 9 out of every 10 of these lived and died in low – to middle income countries; mortality varies 18-fold between the different regions of the world with rates ranging from less than 2 per 100, 000 in Western Asia and Australia / New Zealand to more than 20 per 100, 000 in sub-Saharan Africa. (GLOBOCAN 2012).

The World Health Organisation (WHO) predicts that without immediate action the global number of deaths by this disease will increase by nearly 80 percent in 2030 mostly in low and middle income countries where it accounts for 13 percent of all women cancers.
The disparities in cervical cancer incidence and mortality exist because of a relative lack of effective prevention and early detection and treatment programmes in low to middle income countries compared with the high income countries and the ZCCCPS aims to address this.
While the death rate from cervical cancer is unacceptably high, it can be reduced if the cancer is detected early. The main cause of cervical cancer is human papillomavirus (HPV) infection.
There are many types of HPV. Some types of HPV, called “high-risk types,” can cause cancer of the anus, cervix, vulva, vagina, and penis. They also can cause cancer of the head and neck. Other types have been linked to genital warts.

HPV is sexually transmitted. It is so common that nearly all men and women get it at some point in their lives and can be passed even when an infected person has no signs or symptoms.
Symptoms develop years after being infected, making it hard to know when you first became infected. The disease burden for cervical cancer has been greatly influenced by the high prevalence of HIV and Human Papilloma Virus.

Women who are HIV positive are more susceptible to cervical cancer than those who are not. About 24.7 percent of women in the general population are estimated to be HPV-positive and 17.7 percent women are estimated to be HIV positive.
Lack of information and access to screening and treatment services contributes to the high mortality. Cervical cancer screening coverage is extremely low at 7.2 percent (ICO/WHO 2013), with coverage much lower in rural areas (5.2 percent), as compared to the urban areas (10.8 percent).

While the death rate from cervical cancer is unacceptably high, it can be reduced if the cancer is detected early but because one can have the HPV in their system for more than 10 years without the cancer manifesting itself, it is often diagnosed when it is too late to be treated. And yet screening for cervical cancer is a not a costly exercise.
According to the Centre for Disease Control cervical cancer is the easiest gynecologic cancer to prevent, with regular screening tests and follow-up.

The Pap smear (or Pap test) looks for pre-cancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.
The HPV test looks for the virus that can cause these cell changes The Visual Inspection with Acetic Acid and Cervicography (VIAC). This is a “see and treat”method. It’s simple, painless, results are available immediately and treatment can be offered at the same visit.

In 2010 and 2011, the Ministry of Health and Child Care (MOHCC) with the support of the United Nations Population Fund (UNFPA) set up pilot cervical cancer screening sites using VIAC at United Bulawayo Hospitals (UBH) and Masvingo Provincial Hospital.
VIAC is a see and treat method that is cost effective and minimises delays and the number of visits between screening and treatment. The programme aims to increase the population coverage of cervical cancer screening in the public health sector.
Using lessons learned and experience from the two pilot sites the programme has since expanded and to date, 90screening sites have been established and 164,103 women screened cervical cancer.

A Pap smear is a microscopic examination of cells taken from the cervix can detect certain viral infections such as HPV, which is known to cause cervical cancer.
Early treatment of precancerous changes detected on the Pap smear can stop cervical cancer before it fully develops. A woman may have cervical cancer and not know it because she may not have any symptoms. The HPV test detects high-risk HPV strains in cervical cells.

While some women who are infected with HPV will not develop cervical cancer the following further increase the risk but there are many other unknown factors:
Early sexual debut
Multiple sexual partners
Partner who has multiple sexual partners
HIV infection
Sexually Transmitted Infections (STIs)
Smoking
The risk of being infected with cervical cancer can be reduced by:
Delaying sexual debut
Being in a mutually monogamous sexual relationship
Correct and consistent use of condoms
Vaccination

During the launch Minister Parirenyatwa underlined the importance of delaying sexual debut but also noted the fact that women are having their first sexual experience at a much younger age than before.

To reduce the risk of women getting cervical cancer the MOHCC is rolling out an HPV vaccination program targeting young girls in 2018.  “The necessary preparatory process has been completed and we are ready to start vaccinating
girls aged 10 to 14, thereafter we shall be targeting 9 to 10 year olds,” said Permanent Secretary in the MOHCC, Dr Gerald Gwinji.

He added that the assumption is that older girls are already sexual active and the emphasis on those is screening and awareness. As part of its continued support for the MOHCC, UNFPA along with WHO presented Gweru Provincial Hospital with some cervical cancer treatment equipment on the day of the launch of the ZCCCPS.

Speaking at the launch, UNFPA Assistant Representative, Abbigail Musemburi commended the MOHCC on its commitment to Zimbabwean women and fulfilling the UN Sustainable Development Goals through the development of the strategy.

Source: The Herald Zimbabwe

Sam Dodo

samdodo53@gmail.com

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