By: Adebowale Bello, Freelance Health Writer, with medical review and editorial support by The Datelinehealth Africa Team.
African women face many challenges with cervical cancer care. Click on image to enlarge.
Cervical cancer is one of the leading female cancers worldwide. A 2018 World Health Organisation (WHO) report of the top 20 countries with the highest cervical cancer rate showed that a whopping 19 out of these 20 countries are in Africa.(1)
The Human Papillomavirus (HPV) is responsible for cervical cancer but is an infectious agent that can be vaccinated against. With the aid of regular screenings, it is possible to diagnose and treat cervical cancer and save more lives.
The high mortality rate in Africa makes cervical cancer a critical health issue due to its high prevalence rate and physical, emotional and economic impact on African women.
This article aims to highlight the available treatment options for cervical cancer, the challenges faced by women around the African continent and potential solutions to solve some of these challenges.
One reason cervical cancer is rampant in Africa is the lack of awareness regarding cervical cancer screening.
Though vaccination is highly effective against the HPV, it might not be readily available and affordable in the region, as the high cost of such vaccines makes it inaccessible.
The virus may lead to the early production of cancerous cells, which is treatable only if medical screening programs detect it on time.
Early detection of cancerous cells allows the use of treatment methods which are less invasive but are just as effective, thereby improving your chances of survival.
Cancers occur in stages and cervical cancer is not an exception. The International Federation of Obstetrics and Gynaecology created a staging system(2) to help doctors know what treatment would be most effective for a patient and to estimate recovery time.
There are four stages of cervical cancer and they are (3):
The cancer cells are present in the cervix lining, though they have not spread to other body parts. While still confined here, the tumor may grow in size if left untreated.
The cancer has extended further to other body organs in the pelvic area like the cervical tissue and vagina.
This stage of the cancer is in two forms, IIA and IIB.
In IIA, the tumor is around 4 cm and is limited to the vagina.
In IIB, the cancer has spread from the cervix to the tissue around the uterus.
In stage 3, the cancer has spread to the lower part of the vagina and has proceeded to the pelvic wall, where it could involve either the lymph nodes or kidneys.
The cancer has spread far beyond the pelvis, which contains the vagina, uterus and cervix. The cancer may also have extended to nearby organs like the bladder, colon and rectum.
It could further spread to vital body organs like the liver, lungs and pancreas.
Cervical cancer, like other cancers, can be treated with surgery, radiation therapy and chemotherapy. Depending on the cancer stage, your doctor would recommend treatment options that would best serve your need for effective care.
Here are a variety of these treatment options;
Conization is a surgical procedure carried out when pap smears and biopsy samples do not return reliable results.
It involves cutting a cone-shaped tissue from the cervix, which is examined in the lab to check for the presence of abnormal cancer cells.
Conization is carried out either with a scalpel or a laser. In some cases, an instrument known as a loop electrosurgical excision procedure is used.(4)
Your doctor would recommend this diagnostic surgical procedure if the cancer is suspected to be in its early stages.
The womb holds the growing foetus, and pregnancy is an experience most women look forward to. When a woman has cervical cancer, one of the surgical procedures considered is a hysterectomy.
A hysterectomy, which involves removing the womb entirely or partially, is a significant procedure used to remove a cervical cancer tumor. This is a potentially major surgery that can be classified into three categories based on the tissues or organs removed.(5)
The ovaries and lymph nodes may need to be removed if the cancer has advanced past the initial stages.
Radical trachelectomy is a surgical operation that is similar to radical hysterectomy; however, trachelectomy doesn't involve the womb; instead, it entails the removal of a significant portion of the cervix and the upper section of the vagina.(6)
It is a safe medical technique for women who are still interested in having children because the womb remains intact to allow the foetus to mature. Delivery is typically by caesarean section rather than vaginal birth.
Internal radiation therapy, sometimes referred to as internal radiotherapy or brachytherapy, is a type of treatment that is used to treat some tumors, such as cervical cancer. It involves temporarily sealing a radiation source inside the body.
Usually, the radioactive substance is in a tube that is briefly introduced into the vagina before being removed.
To ensure that all cervical cancer cells are removed, this therapy can be done alone or together with surgery.
External radiation therapy is the more common form of radiation therapy and it involves the use of a machine known as the Linear accelerator (LINAC).
The machine directs high-energy rays to the specific part where the cancerous tumor is located and this treatment method can either be used individually or in combination with chemotherapy.(7)
The duration of radiation may likely be once a day for five days a week or according to your oncologist's discretion.
Pelvic exenteration is a life-changing surgery that involves the removal of the female reproductive organs and other organs located in the pelvic region.
It's usually viewed as an option if the cancer is limited to the pelvic region and has not spread any further.(8)
With the variety of treatment options discussed above, it may seem pretty straightforward for any woman living with cervical cancer to discuss with her doctor and follow up with the best treatment plan as soon as possible, just because her insurance provider has got it covered.
In most African countries, that isn't the case.
There are several challenges which hamper women from seeking treatment and some of them include:
According to a 2022 Statista report, 431 million Africans live in extreme poverty and live on less than $2 a day. With the recent rise in inflation and economic instability, those figures have increased massively.
In Nigeria, the cost of chemotherapy ranged from N600,000 to N1.5 million naira at least while some firsthand reports put the figures at around US$4,000 to US$6,000.
This financial constraint makes it nearly impossible for women living with cervical cancer to access some treatment options as the required funds are not available.
Health insurance plans are meant to cover your medical bills and could be run by the private sector or by the government. They are created to ensure member access to healthcare at the time of need without provider demand for fee-for-service and subject to prior payment of comparatively small and regular funds into a scheme. The uptake of health insurance is still very low in most of sub-Saharan Africa.
This may be due to a number of things, including the fact that African women are less likely to be aware of health insurance, have limited funds or are unable to have access to these programmes.
Most sub Saharan African countries do not have adequate numbers of medical personnel of all categories serving their respective population. To compound the chronic shortage, many sub-Saharan African countries have witnessed a steady departure of its skilled health manpower to other countries of the global north in the last three decades or more. The reasons are multifactorial, but better work and living standards rank high.
A combination of chronic low level manpower, coupled with brain drain in the African health sector, means that there is inevitable shortage of health personnel across all levels of service, from primary to specialist care.
This concerning situation affects the specialty of women's care across the board. For example, fewer gynaecologic oncologists are available to provide effective treatment to women living with cervical cancer.
Consider the following, while the Lancet Commission for Global Surgery (10) recommended 20 Obstetricians and Gynaecologists per 100,000 population for effective service to women globally, Botswana (11) as at 2021 was reported to have only 40 obstetricians and gynaecologists for a total population of 2.3 million (i.e. <0.5/100,000 population); South Africa (12) had 1,292 for a population of 58 million as at 2019 (i.e. approximately 2/100,000 population) and Nigeria (15) in 2013, had 980 obstetricians and gynaecologist for a population of 175 million at the time (i.e., approximately 0.6/100.000 population).
It is obvious from these reported data on shortage of gynaecologist across Africa, that those on the ground would face an increased workload, and due to human factors like burnout, the quality of care that they provide may decline from time to time.
Given the significant rise in survival rates for women with cervical cancer, the significance of early diagnosis cannot be overstated.
Women must have routine medical examinations because cervical cancer is silent, but this is made challenging in many areas by several factors such as;
Lack of awareness about screening services
Aggressive treatment methods, including hysterectomy (total removal of the womb), are also consequences of late diagnosis; nevertheless, even at this time, the efficacy of the procedure may be questionable, and palliative care finally takes centre stage in the course of care.
The challenges which we've discussed above are not the only challenges facing African women who require treatment for cervical cancer.
Through collaborative efforts by individuals and governments, these obstacles can be overcome. Some proposed solutions to the difficulties discussed above include:
1. Financial aid programs: These programs are implemented to help African families who require financial assistance to access treatment options. They could come in the form of direct payments, subsidies or treatment grants.
This initiative reduces the worries about financial exclusion from treatment plans. With the implementation of financial aid programs, there would be a spike in women coming in for screening tests and this early diagnosis may save their lives.
2. Health insurance awareness campaigns: People need to be aware of health insurance plans and to see reasons why they should key into these programs.
Using simple, relatable terms, the goal of these awareness programs should be to explain how health insurance works while highlighting its benefits.
It's also important to help African women realise that health insurance programs are a way of planning for the future. The inexpensive health plans do not require enrollees to part with huge sums of money at once.
3. Training of medical professionals: More medical professionals need to be trained to combat the shortage in the health sector.
Apart from that, the government should make efforts to keep health workers in the country by improving working conditions, providing better career opportunities and offering higher salaries that would serve as incentives for health workers.
4. Cervical cancer awareness programs: African women must be constantly reminded about the importance of early detection of cancer cells and why they should take their health seriously.
Local community health workers can also be trained to operate mobile clinics which are focused on screening tests and this eliminates the need for women living in the rural African areas to make long journeys into the cities.
The World Health Organisation is at the forefront addressing the cancer menace ravaging Africa. In collaboration with private partners, the World Health Organisation has embarked on a pilot phase of proposed cancer care services in 3 African countries namely Zimbabwe, Cote d'Ivoire and Kenya.
This timely initiative is required as statistics have shown that over 70% of all women living with cancer in sub-Saharan Africa are battling with either breast or cervical cancer.
Only one in two women diagnosed with breast cancer in an African country will survive the next five years as compared with a 90% survival rate in other countries.
The initiative includes the following:
This welcome development is going to be closely monitored for three years before it can be extended to other African countries.
Even though cervical cancer is treatable and preventable, African women still face numerous challenges ranging from misconceptions about screening to poverty and shortage of qualified medical personnel.
However, there is hope in the tangible and gradual progress being made in the region. Increased awareness of both the benefits of early cancer screening programs and health insurance funding mechanisms should be scaled up. African governments should endeavor to collaborate with the private sector to improve health care services, reduce cervical cancer and save lives.
Cervical Cancer: What African women need to know
Challenges Of Cervical Cancer Prevention And Care In Africa
Published: May 22, 2023
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