HEALTHY DISCUSSION

Eliminating cervical cancer through awareness, vaccination, screening and treatment

Kenya is vaccinating schoolgirls against cervical cancer a year after WHO Director-General Dr Tedros made an appeal to eliminate it as a public health problem

In Summary

• Past victories over catastrophic diseases through vaccination bear testimony to the importance of interventions

• Fears of vaccinated girls failing to give birth in future should be addressed at community levels by experts

President Uhuru Kenyatta looks on as the Human Papillomavirus (HPV) vaccine is administered to a 10-year-old girl during the launch of the HPV vaccine at Ziwani Primary, Mombasa county.
President Uhuru Kenyatta looks on as the Human Papillomavirus (HPV) vaccine is administered to a 10-year-old girl during the launch of the HPV vaccine at Ziwani Primary, Mombasa county.
Image: PSCU

Remember smallpox, perhaps one of the most catastrophic diseases ever known to humankind? The disease was eliminated in the year 1980 thanks to the robust global immunisation campaign spearheaded by the World Health Organisation (WHO).

Same way, on 19 May 2018, WHO Director-General, Dr Tedros made an appeal to eliminate cervical cancer as a public health problem. True to his word, a draft global strategy to address the elimination of cervical cancer by the year 2030, has since been developed and is awaiting consideration by the 73rd World Health Assembly, through the Executive Board at its 146th session.

Cervical cancer occurs in the cells of the cervix - the neck of the womb [the lower part of the uterus that connects to the vagina]. It is mostly caused by the human papilloma virus (HPV) which is a sexually transmitted infection. Out of the 9.6 million deaths caused by cancer, cervical cancer contribute to 300,000 of these deaths. (WHO).

 

Cervical cancer being the fourth most frequent cancer in women remains one of the greatest threats to women’s health contributing to one death per minute among women. According to WHO, 570,000 new cases of cervical cancer were recorded in the year 2018 and 90% of the deaths that ensued as a result of the disease occurred in low and middle income countries. It is estimated that by the year 2040, the disease could cause over 50% deaths as those reported in the year 2018 if no urgent action is taken. WHO reports that in Kenya, 33 per 100,000 women (5,250) suffer from cervical cancer and 22 per 100,000 women (3,286) die as a result.

Save for death, cervical cancer inflicts much more harm not only to the women diagnosed with the disease but also their support system including their family and friends. These women are our mothers, sisters and daughters, all these women have different roles that they play, they have people who rely on them, they have dreams to concur the world. All that these women are, and hope to be, should not in any way be brought to an end by cervical cancer, more so because it is preventable and treatable.

But why is it that the disease is claiming so many lives even though it is largely preventable and treatable? What would it take to change this state most especially in low and middle-income countries ̶ in Kenya?

There are tools in place to prevent deaths caused by cervical cancer: vaccines such as the HPV vaccine; effective screening techniques necessary for early diagnosis; and effective treatment programs that can treat pre-cancerous conditions.

There are several types of HPV, 2 of which cause 80% of all cervical cancer cases. The HPV vaccine has the potential to substantially reduce the dominance of cervical cancer. In the year 2008, Professor Harald zur Hausen laid a foundation for the development of the HPV vaccine and was awarded the Nobel Prize for demonstrating the connection between HPV and cervical cancer. Recently, the HPV vaccine was rolled out in Kenya with a target of vaccinating 800,000 girls aged 10 years and below.

Screening of cervical cancer is also one of the ways that can mitigate the unnecessary deaths being caused by this disease. Under the Kenya National Cancer Control Strategy 2017-2022, screening is recognised as a vital step towards preventing cervical cancer as it allows early detection and treatment. There are several methods of screening including visual inspection with acetic acid (VIA) and Pap smear. However, even though screening may save a woman from the snares of cervical cancer, the cost of undergoing the required procedure is a great hindrance to many women.

Another barrier that is hindering advancement in addressing cervical cancer in Kenya is lack of awareness about the disease: prevention, the causes [including smoking, early engagement in sexual activities, multiple sexual partners, STD’s and HIV], screening and treatment. It is time to allow some conversations to take place amongst us Kenyans freely. A lot of negativity is associated with some interventions of cervical cancer such as the HPV vaccine and screening. Currently, there are parents who are still against the HPV vaccine that was rolled out, yet it is one of the ways the disease can be defeated.

 

Understandable fears such as, failure of these young girls to give birth in future after receiving the HPV vaccine, should be addressed at community levels by experts through advocacy programs. A lot of education is required from the government, civil societies, NGO’s and even survivors of cervical cancer so that everyone in the country understands the importance of such interventions as a way of eradicating the disease.

Past evidence such as eradication of smallpox and the fight against polio should serve as binding examples of the importance of interventions in eliminating diseases.