Scale up vaccination and screening to reduce cervical cancer cases

Did you know that cervical cancer is the leading cause of cancer-related deaths among women in Kenya? Tragically, it claims the lives of women during their prime years. Most cervical cancer cases are diagnosed between the ages of 35 and 45, a time when most women are raising families, excelling in their careers, and contributing significantly to society.

This disease not only takes away mothers from their children and wives from their husbands, but it also cuts short the promising careers of countless women. The good news is that cervical cancer is nearly 100 per cent preventable. With modern science and healthcare advancements, no woman should have to die from this disease.

January marks Cervical Cancer Awareness Month—a critical time to raise awareness and spread knowledge about prevention and early detection. Awareness can save lives and spare families from the devastating effects of late-stage diagnoses. Remember, waiting for symptoms like pain or abnormal bleeding may mean the disease has already progressed to an advanced stage. Do not wait, take charge of your health today by:

Vaccination

Just as the hepatitis B vaccine prevents liver cancer, the HPV vaccine can prevent cervical cancer. Human papillomavirus (HPV) is responsible for nearly 100 per cent of cervical cancer cases. The HPV vaccine provides immunity against the most common high-risk strains of the virus that cause cervical cancer.

Like all vaccines, the HPV vaccine is most effective when administered before exposure to the virus. HPV is primarily spread through intimate contact and is highly contagious during sexual activity. Because the virus affects skin surfaces, its transmission cannot be completely prevented by condoms.

For this reason, the HPV vaccine is primarily recommended for girls and teenagers aged 10 to 15 and is available at most government clinics for this age group. However, many older women who have not been sexually active or exposed to HPV may also benefit from vaccination. Women are eligible for the vaccine up to the age of 45.

Screening tests

Screening tests are recommended for all women aged 25 to 65, even those who have been vaccinated. The primary goal of screening is to detect abnormal cells early and treat them before they progress to cervical cancer. Treating these abnormal cells is simple and life-saving. After treatment, women can still have their periods, maintain a normal sexual life, carry pregnancies, and deliver vaginally without complications.

In Kenya, there are four main methods for screening cervical cancer:

HPV testing

HPV testing is now recommended as the primary method for cervical cancer screening by the Kenya Ministry of Health, the World Health Organization (WHO), and other international health bodies. This test specifically detects high-risk HPV strains that are linked to cervical cancer.

One of the key advantages of HPV testing is its high sensitivity and accuracy. If your test result is negative, you do not need another test for up to five years. Another significant benefit is that the test does not always require an invasive speculum examination by a healthcare provider. Women can collect the sample themselves in the privacy of their homes or in a restroom at the lab or clinic. Studies have shown that self-sampling is just as accurate as a test performed by a healthcare provider.

So, if fear of an intimate exam has been holding you back, know that HPV testing offers a more comfortable and convenient option. HPV testing is recommended for women aged 30 and above.

Pap smear test

The Pap smear is perhaps the most well-known method of cervical cancer screening. First introduced in 1928 and widely adopted by 1941, the Pap smear has been instrumental in reducing cervical cancer rates. In countries where routine Pap smears are supported by public health systems, cervical cancer is now almost unheard of.

Pap smears should be performed at least every three years, as they are less accurate compared to the HPV testing. For women aged 25 to 30, the pap smear is the recommended screening method.

Pap smear and HPV Co test

The HPV and pap smear co-test is recommended for women between the ages of 30 to 65.  If both are negative, then testing can be done every 5 years. The advantage of the test is that the pap smear will advise if there are any abnormal cells and the HPV test will advise if there is any high-risk infection. 

VIA/VILI testing

Visual inspection with acetic acid and/or Lugol's iodine, commonly known as VIA/VILI, is another method of cervical cancer screening. In this procedure, a healthcare provider examines the cervix using a speculum and applies acetic acid (vinegar) or Lugol's iodine. This is the primary screening method in low-resource areas because it is affordable and does not require laboratory facilities. One of its key advantages is that abnormalities can be detected immediately, and treatment can often be provided during the same clinic visit. VIA/VILI is as sensitive as Pap smears.

However, it is user-dependent, meaning its accuracy relies on the skill of the healthcare provider. This may lead to unnecessary treatment in some cases. Despite this, VIA/VILI remains highly effective at identifying abnormal lesions.

Women with compromised immunity, such as those living with HIV, lupus, or kidney failure, are advised to undergo screening every year. Women who have had a hysterectomy with the removal of the cervix typically do not need cervical cancer screening unless they have a history of highly abnormal pap smears or cervical cancer.

Cervical cancer screening can be discontinued at age 65 if all prior screenings have been normal. However, it may continue beyond age 65 for women with a history of abnormal pap smears or those who have a new sexual partner.

There are many ways to prevent this devastating disease. Vaccinate your daughters and young sisters, engage in regular screenings, and take proactive steps to save lives.

Dr Patricia Muthaura is a Consultant Obstetrician Gynaecologist at Aga Khan University Hospital Nairobi