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Rumbidzayi Zinyuke Health Buzz

This week we continue with our series of cancer awareness articles and our focus is on one of the deadliest cancers affecting women the world over: cervical cancer.

Globally, cervical cancer is the fourth most frequent cancer in women. About 604 000 new cases were recorded in 2020 alone while an estimated 342 000 deaths were reported. Of these deaths, about 90 percent occurred in low and middle-income countries.

In the case of Zimbabwe, cervical cancer is the most common among black women.

The country is actually among the countries with the highest burden of cervical cancer in the world.

Statistics from the National Cancer Registry 2018 report, it accounted for 39,2 percent of the total number of cancer cases followed by breast cancer (12,5percent) and oesophagus (3,8 percent).

Cervical cancer was the leading cause of death among all cancer deaths reported in the country in 2018.

These are indeed worrying statistics!

January is Cervical Cancer Awareness Month so this is a perfect opportunity for us to talk about it.

This is a global healthcare event observed for the entire month of January every year, with the aim of raising awareness of cervical cancer through multiple campaigns and activities to emphasise the importance of early cervical cancer diagnosis, treatment, and preventive recommendations.

This year, 2024, the theme is “Learn. Prevent. Screen” and it emphasises the necessity of educating people with knowledge about minimising cervical cancer risks and the life-saving importance of regular screenings.

As the theme suggests, it is important for people to learn about this form of cancer so that they can prevent it and get screened.

Because when diagnosed, cervical cancer is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively.

So if women are armed with this knowledge, it should make it easier to convince them to get screened for cervical cancer.

Some may ask, what is cervical cancer?

Cervical cancer is a growth of cells that starts in the cervix (the lower part of the uterus that connects to the vagina).

Various strains of the human papillomavirus (HPV), a common infection that is passed through sexual contact, play a role in causing most cervical cancers. When exposed to HPV, the body’s immune system typically prevents the virus from doing harm. In a small percentage of people, however, the virus survives for years. This contributes to the process that causes some cervical cells to become cancer cells.

Experts say it can take between 15 to 20 years for cervical cancer to develop in women with normal immune systems. However, for those with weakened immune systems, such as those with untreated HIV infection, it can take only five to 10 years.

Cervical cancer might not cause symptoms when it starts but these may start to show as it grows.

The symptoms include vaginal bleeding after intercourse, between periods or after menopause, menstrual bleeding that is heavier and lasts longer than usual, watery, bloody vaginal discharge that may be heavy and have a foul odour as well as pelvic pain or pain during intercourse.

As cervical cancer advances, more severe symptoms may appear including persistent back, leg or pelvic pain, weight loss, fatigue, loss of appetite, foul-smell discharge and vaginal discomfort as well as swelling of the legs.

Other severe symptoms may arise at advanced stages depending on which organs the cancer has spread to.

As has been said, when detected early, this type of cancer can be treated.

Treatment for cervical cancer depends on several factors, such as the stage of the cancer and these include surgery, radiation, chemotherapy or a combination of the three.

But for patients in Zimbabwe, cancer treatment comes with unbearable costs which most cannot afford.

And this is the reason why many will not seek medical care and eventually succumb to cervical cancer.

What they may not be aware of is that prevention is the most cost effective way of dealing with cancer.

Health experts say it is important for women to know the risk factors for cervical cancer so that they can be avoided.

These include smoking which increases the risk of cervical cancer because when HPV infections happen in people who smoke, the infections tend to last longer and are less likely to go away.

It is also important to know that the greater the number of sexual partners, the greater a woman’s chances of getting HPV.

Early sexual activity is also a red flag as it can increase the risk of cervical cancer later in life and having other sexually transmitted infections that include herpes, chlamydia, gonorrhoea, syphilis and HIV/AIDS are also big risk factors.

If women get this information early on in life, they can save their own lives by avoiding these risk factors.

For low and middle income countries, vaccination against HPV as well as screening are also key.

Zimbabwe has an ongoing HPV vaccination programme targeting girls between the ages of nine and 14 years. This is done mostly in schools and health centres across the country to ensure that all girls can be reached.

This means these young girls, who have not had their sexual debut will be protected as they grow older.

But for the older women who cannot get the vaccine, screening becomes the most important tool in fighting cervical cancer.

The goal for screening for cervical cancer is to find pre-cancerous cell changes early when treatment can be offered to prevent cancer form developing.

The main ways to screen for cervical cancer include the HPV test to check for infection that can cause cervical cancer, a pap smear (cervical cytology) where cervical cells can be checked for changes caused by HPV that may turn into cervical cancer if left untreated.

A pap smear can also sometimes detect conditions that are not cancer.

Zimbabwe has made strides in ensuring that many women, particularly those in marginalised communities can access screening services through the Visual Inspection with Acetic Acid and Camera (VIAC) services offered for free at various health centres.

VIAC involves examining the opening of the womb, or the cervix, for changes that might lead to cancer. If these changes are detected early, the cells can be eliminated before they become cancerous.

Screening is usually recommended from the age of 25 in the general population of women, with regular screening every three years while women living with HIV also need to be screened more frequently.

Cervical screening on a regular basis can help in preventing both localised and non-localised cervical cancer.

Screening must however be linked with treatment and management for those with positive screening tests.

Despite being a preventable and curable disease, cervical cancer continues to bring untold pain and suffering to women and girls around the world hence the need for strategies on how to end this challenge.

The World Health Assembly adopted the global strategy to accelerate the elimination of cervical cancer as a public health problem.

Countries are expected to reach the threshold of less than four cases of cervical cancer per 100 000 women per year for them to be classified in the elimination of cancer stage.

Zimbabwe and indeed many other countries in the region will need to put extra effort towards the attainment of these goals.

This means we need more investment towards screening, vaccination and treatment of cervical cancer.

But in the meantime, investment in awareness raising is needed more. People need to be aware of what cervical cancer is and how they can prevent it.

If people are aware, they make informed decisions.

Then we can then start talking about elimination of cervical cancer as a public health threat.

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