Cervical Cancer Prevention

Background of Cervical cancer

  1. The burden of cancer of the cervix

Cervical cancer is one of the commonest cancers in women worldwide, it is the third most common cancer estimated 530 000 new cases in 2008 worldwide. Cervical cancer continues to be among the leading devastating causes of death among women in Sub-Saharan Africa, most of which could be prevented. (WHO International Agency for Research on Cancer (IARC) 2010).

Tanzania suffers one of the highest cervical cancer burdens in the world and the highest in Eastern Africa. It is the leading cause of cancer related morbidity and mortality in women, where the vast majority of cervical cancer patients are usually seen at the late stage of evolution of the disease, which reduces the chances of survival. In 2009 cervical cancer accounted for 35.3% of all cancer patients seen at Ocean Road Cancer Institute (ORCI), about 80-85 % are treated in advanced stages where palliative care to relieve symptoms is the only option. (ORCI cancer registry 2009).

2. Causes

Virtually all cervical cancers are associated with human papilloma viruses (HPV). High risk HPV for developing cervical dysplasia and cancer 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82. HPV recognized many years ago as the cause of warts now known to be linked to cervical cancer. HPV is (sexually transmitted infection) BUT most infections are transient, Only HPV that persists can lead to cervical cancer.

  1. Risk factors

 All women are at risk but risk is increased by:

Early sexual intercourse below 18 yrs., multiple sexual partners, exposure to sexually transmitted infections (STIs), HIV (or other immunosuppressant’s), mother or sister with history of cervical cancer & smoking.

In HIV-infected women

HPV detected more frequently; resolves more slowly, HPV-associated diseases more difficult to treat. Progression to pre-cancerous lesions are accelerated, precancerous changes takes short time to progress to cancer. Most precancerous lesions spontaneously regress, to women who are not infected with HIV usually takes 10 years or more to progress to cervical cancer.

 

  1. Cervical Cancer Prevention (CECAP)

Primary prevention: abstinence and safer sex, behavior change and vaccination of adolescent girls before they become sexually active. Several initiatives to address cervical cancer prevention have started in the country but these initiatives are still scattered and need to be consolidated in a National Strategic Plan, they will serve as building blocks to expand screening services, vaccination, care and treatment of cancer patients.

Secondary Prevention; identification and treatment of precancerous lesions (Cervical Cancer Screening- CCS) Cervical cancer is almost 100% preventable but must be detected early and treated.

Screening & treatment methods:

  1. Visual inspection with acetic acid (VIA)

Screening of women aged 30 to 50 years to identify precancerous lesions (VIA pos) and treat small lesions by freezing method using carbon dioxide gas or Nitrous oxide gas (cryotherapy)for clients identified with small lesions have been effective in preventing cervical cancer.  A "see and treat approach" are performed at primary health care level & it is an outpatient procedure. It is an evidence-based alternative to non-invasive approach; effective, feasible, highly acceptable and sustainable in low-resource settings, which promotes linkage of screening with treatment, simple & affordable table vinegar.

A picture showing cryotherapy instruction during training.

 

2.Treatment of large lesions

 For the large lesion, the use of invasive procedure, Loop Electrosurgical Excision Procedure (LEEP) is applied. LEEP is the removal of abnormal areas from the cervix using a thin wire heated with electricity.  Indicated for large lesions not treatable with cryotherapy & it is successful in curing large pre-cancerous lesions.

 

3.PAP smear

It is an old known method of screening to detect cervical cancer, BUT it is expensive to the majority it requires laboratory tests and skilled pathologist.

4.AVAILABLE CECAP DATA 2012- March, 2017

Indicator HIV pos HIV neg Unknown Total
No of clients received VIA screening 21418 29460 4332 55210
No of clients with POS VIA results 1448 1174 250 2872
No of clients referred for large lesion 176 91 15 282
No of clients referred for suspect cancer 173 241 52 466
No of clients received cyotherapy 1381 997 195 2573
No of clients with LEEP performed 172

 

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