How poverty and misdiagnosis delay cervical cancer care

Every week, I witness a profoundly tragic scene: a young woman and her extended family sitting across from me in the consultation room. They carry a stack of reports from various healthcare facilities—a silent testament to the long, arduous journey that led them to my door.

On further questioning, the woman typically reports that her problem began one to two years prior, starting with vaginal bleeding. In most cases, she was initially treated for an "infection" and sent home. She would then attend various healthcare facilities, where multiple tests were conducted and further medication or reassurance was offered.

Only when her symptoms worsened—becoming a malodorous vaginal discharge, backache, persistent bleeding, or the passage of stool through the vagina—would she embark on another journey to seek help. This pattern is the typical presentation of advanced cervical cancer.

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Cervical cancer is a leading cause of cancer-related deaths among women in low- and middle-income countries. 

According to the World Health Organization (WHO), it is the foremost cause in Kenya, with a 12 per cent mortality rate among those diagnosed—higher than the nine per cent for breast cancer. It affects women across all demographics. 
Crucially, the disease has a detectable and treatable precancerous phase. If women undergo readily available screening, early-stage disease can be identified and effectively treated.

It is highly recommended that women aged 21 to 29 undergo a Pap smear every three years to screen for cervical abnormalities. From age 30 onward, Pap tests should be combined with HPV testing; this co-testing should be performed every five years until the age of 65. Cervical cancer is the most common disease caused by HPV, and nearly all cases of cervical cancer are attributable to HPV infection.

Women with compromised immunity such as those living with HIV, lupus, or kidney failure are advised to undergo annual screening. However, women who have had a hysterectomy with removal of the cervix no longer require cervical cancer screening, unless they have a history of highly abnormal Pap smears or cervical cancer.

WHO recommends that comprehensive cervical cancer control include primary prevention through HPV vaccination, secondary prevention via screening and treatment of pre-cancerous lesions, tertiary prevention involving the diagnosis and treatment of invasive cancer, and palliative care.

The HPV vaccine schedule differs by age. Girls and boys aged 11–12 require two doses, administered at least six months apart. For those who start the series later, between ages 15 and 26, three doses are needed.

Consequently, increasing awareness of cervical cancer at the primary care level is vital for reducing its burden. 

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If all healthcare providers recognise its signs and symptoms and maintain a high index of suspicion, fewer women will be missed. Offering opportunistic screening to every woman who visits a healthcare facility, regardless of her initial complaint, would significantly expand screening coverage.

Poverty is a significant barrier to accessing quality healthcare. Establishing universal health coverage is therefore essential to ensure equitable access to both preventive and curative cancer services. At the national level, numerous actions can be taken to reduce unnecessary cancer deaths.

Paramount among these is raising public awareness of the disease—its symptoms and its severity Effective intervention and improved outcomes will only be possible through the concerted effort of all stakeholders.

Dr Warfa is a consultant gynaeoncologist at Aga Khan University Hospital Nairobi