This week was the first national Cervical Cancer Awareness week in Kenya. Stakeholders, including government agencies, national hospitals, and non-governmental organisations put together a series of activities aimed at increasing awareness of cervical cancer and promote screening and prevention of the disease.
A recent newspaper column stated, “between January 1 and December 31, 2018, Kenya lost 32,987 people to cancer, of which the majority were women”. Another Kenyan wrote in saying “I think it is very unfortunate. Women have always been victims. As Kenya aims for UHC, this should be a priority.”
Indeed, with the current drive and enthusiasm to realise Universal Health Care in Kenya lies an incredible opportunity to save the lives of countless Kenyan women from cervical cancer, the second most common cancer among Kenyan women.
According to the Ministry of Health, approximately 2,500 Kenyan women are diagnosed with cervical cancer each year. The majority of these women go on to die sad and painful deaths, because of the lack of adequate treatment in the late stages in which the cancer is often diagnosed. This story is not unique to Kenya. Of the approximately 250,000 cases of cervical cancer diagnosed around the world, 90 per cent of the cases are diagnosed in developing countries. The saddest part is that this cancer is entirely preventable through vaccination, screening and early diagnosis.
The reason why Kenya and similar countries shoulder a disproportionate burden of cervical cancer is because of a lack of widespread screening programs. Indeed, the latest figures estimate only 3-5 per cent of Kenyan women have ever been screened for this cancer.
For many years, the only reliable test to screen for cervical cancer was the Pap smear, a test whose widespread use has resulted in a dramatic drop in rates of cervical cancer in developed countries. However, the test is hard to implement in low-resource countries and primarily in rural areas because it requires a pelvic exam, significant infrastructure including a trained pathologist to interpret the test as well as multiple clinic visits.
Now, thanks to many years of scientific research, a new test to screen for cervical cancer is available — the Human Papillomavirus test (HPV) test. Unlike the Pap smear, HPV-testing does not require a pelvic exam, as women can be taught to collect the sample by themselves.
This is hugely significant particularly in the African setting where cultural barriers prevent many women from presenting for this life-saving screening. With HPV-self testing, women can perform the test in the comfort of their homes, or a private area within a medical clinic, or during a community campaign. With the current technology, HPV testing can produce a same-day result, allowing women who screen positive to get immediate treatment. Never in history has science provided us with an opportunity to prevent a cancer and save the lives of so many women.
Would self-collection of samples be acceptable to women, some may ask?
Yes! A study involving 100,000 women in multiple countries including India and Uganda has shown women found self-collection of the HPV-specimen to be highly acceptable and easy to understand and perform. This is incredible news for women who may not have easy access to physicians, or for whom cultural traditions may preclude them from presenting to a pelvic exam.
Widespread implementation of HPV self-testing for all women truly has the potential to save lives.
The HPV-test, which allows for patient self-collection, is currently available in Kenya. With the current implementation of UHC pilot programs, it is imperative that policymakers include cervical cancer screening with self-collected HPV-tests as part of the services offered. This should be coupled with vaccination against the HPV-virus for young girls age 9-14 years old, as recommended by the WHO.
We must embrace this opportunity as a country who values the lives of its daughters, mothers, sisters.
Dr Chemtai is a gynaecologist