Poor services aggravate terrible cervical cancer toll

In sharp contrast to global trends, cervical cancer is the leading cause of cancer deaths among SA women, according to a new report by the World Health Organisation (WHO).

For women in SA, the three leading cancers ranked by deaths are cervical, breast and lung cancer. Globally, they are breast, lung and colorectal.

SA has a high prevalence of cervical cancer due in part to the large HIV epidemic, but the fact that so many women are dying from a preventable and treatable disease is largely due to the failings of the public health system, said Cancer Association of SA CEO Lorraine Govender.

HIV makes women more vulnerable to infection with the human papilloma virus, which causes cervical cancer. It can be prevented with vaccines and is treatable if caught early enough.

Many women do not have regular screening tests and are diagnosed when the disease has already progressed, worsening their prognosis, said Govender.

While a minority of women who can afford private healthcare have ready access to screening tests and treatment, most women in SA rely on the overburdened public sector.

Government guidelines say women living with HIV should have annual pap smears to check for cervical cancer but many women do not have regular checks and if they do, they face extensive delays, she said.

“Women should not be dying from cervical cancer.

“But women go for pap smears, wait four to six weeks for results, and have to wait again for further investigations such as a colposcopy or biopsy. They face further delays for treatment and may have to wait three to six months for radiation,” she said.

Among men, the three leading causes of cancer deaths in SA are lung, prostate and colorectal cancer. Globally the top three cancer killers among men are lung, liver and colorectal.

SA has a relatively high burden of death from prostate cancer because men who rely on the public sector are offered tests only if they have symptoms that warrant further investigation, said Govender.

In the private sector, men are offered prostate cancer screening from the age of 50.

The latest data from the WHO’s cancer agency, the International Agency for Research on Cancer (IARC), shows there were 20-million new cancer cases and 9.7-million cancer deaths worldwide in 2022. In SA, there were an estimated 111,321 new cancer cases and 64,547 deaths.

The most common cancer diagnosis among women in SA was breast cancer (25%), followed by cervical (17.9%), and colorectal (5.9%). For men the most frequent cancer diagnoses were prostate (24.6%); lung (11.6%) and colorectal (7.4%).

The fact that cancer deaths in SA are skewed towards those that could be treated if they are caught early is in line with the WHO report, which found cancer has a disproportionate effect on poor and underserved populations. In countries with a high human development index (HDI), one in 12 women will be diagnosed with breast cancer in her lifetime and one in 71 will die from it, said the WHO.

But in countries with a low human development index only one in 27 women is diagnosed but one in 48 will die from it.

“Women in lower HDI countries are 50% less likely to be diagnosed with breast cancer than women in high HDI countries, yet they are at a much higher risk of dying due to late diagnosis and inadequate access to quality treatment,” said IARC deputy head of cancer surveillance Isabelle Soerjomataram.