Cervical cancer- Just because she did not check in time
Mar 07, 2010
IN Uganda cervical cancer is the leading killer of women outside the child-bearing age bracket. The country has one of the highest cervical cancer death rates in the world.
By Irene Nabusoba
IN Uganda cervical cancer is the leading killer of women outside the child-bearing age bracket. The country has one of the highest cervical cancer death rates in the world.
“Over 80% of women with the cancer are diagnosed with the disease in advanced stages that is difficult to treat,†says Dr. Emmanuel Mugisha, the country director of PATH, a non-profit global health organisation pioneering the fight against the cancer in Uganda.
A study by the health ministry and PATH shows that 67% of bed occupancy in the gynaecology ward of Mulago is of cervical cancer cases and 70% of the women who die in this ward are cervical cancer patients.
Dr. Daniel Murokora, the president of the Uganda Obstetrician and Gynaecologists Association, says the disease accounts for up to 40% of cancer cases recorded in the Kampala Cancer Registry.
“Cervical cancer is one of the leading 10 cancers in terms of incidence and mortality. Up to 45.6 per every 100,000 women suffer cervical cancer, according to records from the Cancer Registry,†Murokora says.
“It affects women although men are also affected indirectly. Marriages break and women are stigmatised because they are alienated due to a smelly discharge that cannot go away even with use of antibiotics,†he explains.
Magnitude of cervical cancer
According to Mugisha, cervical cancer affects 500,000 women with 270,000 of them succumbing to the disease. Nearly 85% of these women live in low-income countries, like Uganda, where access to routine health care is limited,†he says.
“The death rates are high because there are no systematic screening programmes to detect it early. Once you screen it early, you can treat it,†he says.
Developed countries with adequate resources like in Europe, run cervical cancer screening programmes. This has tremendously reduced the cancer to less than 10 of every 100,000. They start screening at 18years and do annual pap smears (tests that detect the cancer).
“We need infrastructure to process slides and provide results immediately when the problem is found. But our screening programmes are still handicapped, taking up to two weeks or more before mothers can receive results.
This affects the ability of the women to pick their results, while others stay longer until they develop full blown cancer,†he says.
Challenges
“Cervical cancer screening is not yet widely available. We have a few centres like Nkurumah KCC Clinic, Kawempe Health Centre IV and Mulago Hospital where there is free screening, but all these centres are in Kampala,†Mugisha says.
In other areas, the visual inspection procedure costs between sh5,000 to sh20,000. “The cost makes it hard for women to go for screening, especially when they are not sick,†he adds.
“We need laboratories and supplies,†he says. One would have to pay about sh30,000 for a more advanced procedure like a pap smear test, excluding the consultation fee.
Dr Murokora says:“We screen women aged 25 to 50. We majorly use acetic acid and recommend that women have the test every three years. In case of any pointers, we take a biopsy for further evaluation.â€
Research shows that low-tech visual inspection methods, for example the use of acetic acid (vinegar), which is applied to the cervix, could be the cheapest alternative.
However, health professionals argue that many healthcare providers have not been trained to use the method.
Because standard screening services such as pap smears are technically difficult and expensive for widespread adoption in developing countries, Sarah Nyombi, the MP for Ntenjeru North county calls for vaccination because it can prevent up to 70% of cervical cancer cases among vaccinated women.
The three-doze regiment goes for $360 (about sh640,800) in developed countries. Developing countries struck a deal with the pharmaceutical companies and are buying at $50 (about 89,000).
While vaccination is only limited to 10 to 12-year-old girls, pharmacists say even adults can get the vaccination.
Without broad access to HPV vaccines and effective low cost screening tools, researchers project that by 2050, more than a million women will suffer from cervical cancer annually.
“In Uganda, of every 100 cases detected, we would only have 20 women alive in five years because the majority are diagnosed late. Pre-cancels rarely recur. The cancer may recur but we have no systematic national interventions,†he says.
“We vaccinate and do secondary screening so that if the cancer cells are found, they are destroyed before they become cancerous.
But our interventions are still scattered. The WHO, Uganda Women’s Health Initiative and PATH are conducting interventions in Masaka, Mbarara, Mbale, Soroti, Itojo, Ibanda, Nakasongola and Kampala. But what about the rest of the country?†he asks.
The health ministry and its partners implemented the national strategic plan on March 2. The plan will guide the implementation of screening and treatment programmes.
“We hope to move outside the pilot districts and clinics to regional referral hospitals for about three years and to district hospitals, health centre IVs until the grassroots,†he says.
“But we require resources to support earmarked arms of intervention. We have done vaccination in only in Nakasongola and Ibanda districts,†he says. “With about sh70m, you can handle regional referrals per year and thereafter, sh40m when everything is in place.
Symptoms
Heavy bleeding
A thick smelly discharge, pelvic pain
Pain when urinating.
The cancer is slow-growing, providing room for intervention.
Causes
Early sexual intercourse (before 16 years)
Frequent short-spaced and many births as well as many sexual partners
Lifestyle factors such as smoking and alcohol consumption
Risk Factors
Unprotected sex
HIV infection
Long-term use of hormonal contraceptives
Co-infection with chlamydia, or the herpes virus
How does the cancer develop?
Dr. Daniel Murokora, the president of the Uganda Obstetrician and Gynaecologists Association, says cervical cancer is the uncontrolled growth of cells on the cervix, known to be caused by the Human Papilloma virus (HPV); a sexually transmitted infection.
The cancer develops from a precancerous stage, taking a decade before developing into an overt cancer. The HPV infection is necessary but not sufficient to cause cervical cancer as most infections resolve spontaneously within one to two years.
However, some infections persist, becoming a chronic infection that could drive the cells of the cervix to grow abnormally, hence the precancerous lesions.
The papiloma virus might clear on its own, but if it persists the cervix undergoes changes that could progress to cancer. “This takes about 10-15 years,†Murokora says.
He says early detection and treatment can yield a 100% cure. But while research shows that cancer control programmes can go a long way in preventing cervical cancer and reducing the unnecessary morbidity and loss of life, Ugandans are succumbing to the ailment unnecessarily.
IN Uganda cervical cancer is the leading killer of women outside the child-bearing age bracket. The country has one of the highest cervical cancer death rates in the world.
“Over 80% of women with the cancer are diagnosed with the disease in advanced stages that is difficult to treat,†says Dr. Emmanuel Mugisha, the country director of PATH, a non-profit global health organisation pioneering the fight against the cancer in Uganda.
A study by the health ministry and PATH shows that 67% of bed occupancy in the gynaecology ward of Mulago is of cervical cancer cases and 70% of the women who die in this ward are cervical cancer patients.
Dr. Daniel Murokora, the president of the Uganda Obstetrician and Gynaecologists Association, says the disease accounts for up to 40% of cancer cases recorded in the Kampala Cancer Registry.
“Cervical cancer is one of the leading 10 cancers in terms of incidence and mortality. Up to 45.6 per every 100,000 women suffer cervical cancer, according to records from the Cancer Registry,†Murokora says.
“It affects women although men are also affected indirectly. Marriages break and women are stigmatised because they are alienated due to a smelly discharge that cannot go away even with use of antibiotics,†he explains.
Magnitude of cervical cancer
According to Mugisha, cervical cancer affects 500,000 women with 270,000 of them succumbing to the disease. Nearly 85% of these women live in low-income countries, like Uganda, where access to routine health care is limited,†he says.
“The death rates are high because there are no systematic screening programmes to detect it early. Once you screen it early, you can treat it,†he says.
Developed countries with adequate resources like in Europe, run cervical cancer screening programmes. This has tremendously reduced the cancer to less than 10 of every 100,000. They start screening at 18years and do annual pap smears (tests that detect the cancer).
“We need infrastructure to process slides and provide results immediately when the problem is found. But our screening programmes are still handicapped, taking up to two weeks or more before mothers can receive results.
This affects the ability of the women to pick their results, while others stay longer until they develop full blown cancer,†he says.
Challenges
“Cervical cancer screening is not yet widely available. We have a few centres like Nkurumah KCC Clinic, Kawempe Health Centre IV and Mulago Hospital where there is free screening, but all these centres are in Kampala,†Mugisha says.
In other areas, the visual inspection procedure costs between sh5,000 to sh20,000. “The cost makes it hard for women to go for screening, especially when they are not sick,†he adds.
“We need laboratories and supplies,†he says. One would have to pay about sh30,000 for a more advanced procedure like a pap smear test, excluding the consultation fee.
Dr Murokora says:“We screen women aged 25 to 50. We majorly use acetic acid and recommend that women have the test every three years. In case of any pointers, we take a biopsy for further evaluation.â€
Research shows that low-tech visual inspection methods, for example the use of acetic acid (vinegar), which is applied to the cervix, could be the cheapest alternative.
However, health professionals argue that many healthcare providers have not been trained to use the method.
Because standard screening services such as pap smears are technically difficult and expensive for widespread adoption in developing countries, Sarah Nyombi, the MP for Ntenjeru North county calls for vaccination because it can prevent up to 70% of cervical cancer cases among vaccinated women.
The three-doze regiment goes for $360 (about sh640,800) in developed countries. Developing countries struck a deal with the pharmaceutical companies and are buying at $50 (about 89,000).
While vaccination is only limited to 10 to 12-year-old girls, pharmacists say even adults can get the vaccination.
Without broad access to HPV vaccines and effective low cost screening tools, researchers project that by 2050, more than a million women will suffer from cervical cancer annually.
“In Uganda, of every 100 cases detected, we would only have 20 women alive in five years because the majority are diagnosed late. Pre-cancels rarely recur. The cancer may recur but we have no systematic national interventions,†he says.
“We vaccinate and do secondary screening so that if the cancer cells are found, they are destroyed before they become cancerous.
But our interventions are still scattered. The WHO, Uganda Women’s Health Initiative and PATH are conducting interventions in Masaka, Mbarara, Mbale, Soroti, Itojo, Ibanda, Nakasongola and Kampala. But what about the rest of the country?†he asks.
The health ministry and its partners implemented the national strategic plan on March 2. The plan will guide the implementation of screening and treatment programmes.
“We hope to move outside the pilot districts and clinics to regional referral hospitals for about three years and to district hospitals, health centre IVs until the grassroots,†he says.
“But we require resources to support earmarked arms of intervention. We have done vaccination in only in Nakasongola and Ibanda districts,†he says. “With about sh70m, you can handle regional referrals per year and thereafter, sh40m when everything is in place.
Symptoms
Heavy bleeding
A thick smelly discharge, pelvic pain
Pain when urinating.
The cancer is slow-growing, providing room for intervention.
Causes
Early sexual intercourse (before 16 years)
Frequent short-spaced and many births as well as many sexual partners
Lifestyle factors such as smoking and alcohol consumption
Risk Factors
Unprotected sex
HIV infection
Long-term use of hormonal contraceptives
Co-infection with chlamydia, or the herpes virus
How does the cancer develop?
Dr. Daniel Murokora, the president of the Uganda Obstetrician and Gynaecologists Association, says cervical cancer is the uncontrolled growth of cells on the cervix, known to be caused by the Human Papilloma virus (HPV); a sexually transmitted infection.
The cancer develops from a precancerous stage, taking a decade before developing into an overt cancer. The HPV infection is necessary but not sufficient to cause cervical cancer as most infections resolve spontaneously within one to two years.
However, some infections persist, becoming a chronic infection that could drive the cells of the cervix to grow abnormally, hence the precancerous lesions.
The papiloma virus might clear on its own, but if it persists the cervix undergoes changes that could progress to cancer. “This takes about 10-15 years,†Murokora says.
He says early detection and treatment can yield a 100% cure. But while research shows that cancer control programmes can go a long way in preventing cervical cancer and reducing the unnecessary morbidity and loss of life, Ugandans are succumbing to the ailment unnecessarily.