Why cervical cancer continues to kill women

Malam Abdullahi struggles to repress the painful memories of his wife’s battle with cancer of the cervix.

“We never knew it was cancer. Binta was bleeding between menstrual periods, and we mistook it for the menstrual cycle. She will complete a cycle, and after five to seven days, she starts seeing blood again, it was on and off like that,” he recalled.

“She complained of intermittent back pain, and she will take pain reliever. But then the pain radiated to the thigh and became unbearable and by the time we got to the hospital, the specialist told us it was cancer and that it was at the late stage. We lost her eventually.”

In 2018, approximately 311,000 women died from cervical cancer, the World Health Organisation (WHO) statistics revealed. More than 85% of the deaths reportedly occurred in low and middleincome countries.

With an estimated 570,000 new cases in 2018, cervical cancer ranked the second most common cancer in women living in less developed regions.

The International Agency for Research on Cancer, GLOBOCAN 2018, puts deaths from cervical cancer in Nigeria at 10,403, and new cases at 14,943, representing 21 per cent of 71,022 new cancer cases in all females in the country.

Dr Usman Malami, Pioneer Head of Department of Radiotherapy and Oncology, Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, pointed to a significant problem of late presentation. Many come with advanced disease, he said.

“The disease can be treated if you present early, but if you present late-stage (stage 4), when the disease has spread to other parts of the body, nobody can do anything for you. The same applies to other types of cancers. If you present at stage 1and 2, at least something can be done; at stage 3 yes we can give chemotherapy and radiotherapy.”

He said the symptoms included abnormal bleeding from the private part. “This bleeding could be intermenstrual, passing blood after sexual intercoursethe post-coital bleeding, abnormal discharge, foul smell, and pains.”

The Consultant Clinical and Radiation Oncologist harped on prevention, early diagnoses, effective screening and treatment programmes, adding that “cervical cancer is one of the cancers that we are fortunate to know the cause. The cause is a virus – the human papillomavirus.”

However, delay in access to diagnosis and treatment is a bane of cancer prevention in the country, stakeholders observed.

While cervical cancer is, according to experts, preventable by PAP smear and HPV vaccines, the disease continues to result in the death of thousands of women.

Why are women not having PAP Smear? If it is vaccine-preventable, why does cervical cancer remain a leading cause of cancer death in the country?

In countries where regular cervical cancer screening is reportedly practiced, statistics indicate that the incidence and mortality have dropped, leaving Nigeria and some other developing countries behind.

The GLOBOCON 2018 World Cancer report placed cervical cancer at 9th position worldwide in terms of incidence and mortality while in Nigeria, and some other developing countries, it is second as reflected earlier.

Commenting on cervical cancer PAP test, Aisha Sani, a caregiver, asserts “I was not aware of such screening until we had a cervical cancer patient.”

Amina Rufai on her part was learning about PAP smear for the first time. “I do not know anything on what you are talking about,” she says. But some others showed a certain level of awareness of such test, while has some expressed reservation.

The position of the cervix in the body (between the vagina and uterus), make them reluctant going through the screening.

Dr Malami confirms: “Hardly do you see anybody coming to the hospital for that, we have had some few but very rare. Cancer screening patronage is extremely low in the northern part of the country.

“The knowledge is important; you have to empower people, empower women.”

On the vaccine, the oncologist asserts: “We are pushing for the federal government to provide the vaccines. If we can immunise our female children 9-13 years, with that vaccine, they are well covered.”

Almost all of the cervical cancer deaths, WHO says, could be avoided if known effective interventions were available to all women and implemented, including immunising adolescent girls against human papillomavirus (HPV) and cervical screening and treatment of pre-cancerous lesions.

Still, the cost of treatment remains a huge concern to a majority of the patients who are calling on government to provide essential service by enrolling leading cancers such as breast cancer, cervical cancer, and prostate cancer, into the National Health Insurance Scheme (NHIS).

There were renewed appeals for the government to revive the country’s cancer centres of excellence, and ensure that the National Cancer Control Programme launched last year, was effectively implemented to reduce cancer burden and improve services for cancer patients.