TECHNOLOGICAL ADVANCEMENT IN FIGHT AGAINST CERVICAL CANCER
CERVICAL cancer is the second most common cancer among women in South Africa, after breast cancer and is often fatal.
In 2012, there were 5785 new cases of cervical cancer.
It occurs as a result of infection with the human papilloma virus (HPV). This virus is sexually transmitted and in South Africa, there are very high infection rates with HPV. Cervical cancer is a relatively unique cancer in that it has a long “precursor” or early phase, during which risk and abnormalities can be detected by screening.
If a positive screening test is left untreated, a woman is at high risk of developing cervical cancer over a five to 30 year period.
If cervical cancer is identified soon after an infection occurs, progression to invasive cancer of the cervix can be prevented. INTERVENTIONS
So what is the health system doing around cervical cancer? There are three main interventions.
Firstly and most importantly is prevention. In 2014, the National Department of Health introduced a new vaccine, the HPV vaccine, which is given to girls in grade 4 as part of the Integrated School Health Programme.
This vaccine is given to girls who are not yet sexually active to prevent infection with HPV and in the long term will have the effect of reducing the numbers of women who develop cervical cancer.
Another activity that is used to prevent cervical cancer is to promote awareness of how the cancer occurs and to encourage prevention of getting HPV infection through safe sex practices and dual protection (regular use of condoms plus other methods of contraception).
Secondly there is early detection and treatment of what is called “cervical pre-cancer”, when the cells in the cervix are not yet fully malignant but well on their way to being so.
South Africa has a policy that makes provision for all women over the age of 30 years to have three free cervical cancer screening tests. Ideally these are done at ten year intervals in the public health sector at ages thirty, forty and fifty.
Women who are HIV positive are more likely to develop cervical cancer and should have more frequent screening.
Organised cervical cancer screening for eligible women is the central element within the department’s cervical cancer secondary prevention strategy. If a woman is diagnosed as pre-cancerous she is referred for further testing and treatment.
The third intervention to provide timely treatment and palliative care for invasive cervical cancer that has spread beyond the cervix.
This requires referral to sophisticated cancer treatment in usually big referral hospitals where a range of treatments including surgery, radiotherapy and chemotherapy are available. REVISED AND UPDATED CERVICAL CANCER POLICY AND GUIDELINES
The Department of Health has recently reviewed and updated its cervical cancer.
One of the principles is to ensure that the available resources are used optimally and that each woman in South Africa has a fair chance of receiving the benefits of prevention, screening and treatment according to her needs.
For example in line with the guidelines of the World Health Organisation, women living with HIV, women with other immunosuppressive conditions, sex workers, adolescents, and migrants all have special different needs and these are catered for in the policy.
The policy provides for the training of health staff to effectively screen, diagnose, manage and treat cervical pre-cancer and guidelines for referral to ensure continuity of care for women with positive screening test results.
Finally it emphasises the importance of community mobilisation to encourage women to go to facilities for cervical screening tests.
It explains the role of civil society organisations and provides for a communication strategy to increase awareness of cervical cancer at the community level as well as increase demand for and utilisation of cervical cancer prevention and control services. FACTORS CONTRIBUTING TO HIGH CERVICAL CANCER
INCIDENCE IN SOUTH AFRICA The following factors contribute to high incidence rates, especially among black and HIV-positive women. These factors have therefore been taken into consideration in this revised policy: Socio economic status and place of residence (urban versus rural): Women who live in rural areas are disadvantaged regarding access to appropriate information and access to services. Even in some cases where a woman has access to a primary healthcare facility for screening, her referral to the next level of care is delayed due to poverty or financial challenges. Educational level: The default community messaging strategy is through written material. Furthermore the medium of communication is in English, which excludes most of the women living in rural areas, whose first language of communication is not English. Social arrangement of the family: Women in some communities are largely not decision makers in relation to health seeking patterns, especially for sexual and reproductive health issues, due to their economic reliance on their male partners. In other communities the decision to seek medical advice is made by the elderly woman in the family who may not be adequately informed. Access to services: The healthcare system in South Africa is still largely hospi-centric with a focus on curative care. In addition, the availability of specialised health care services in South Africa is not equitably distributed according the needs of the community. Thus there are areas where advanced services are available and accessible while other parts of the country only offer basic healthcare services. The situation is exacerbated by the severe shortage of specialists such as oncologists, radiation oncologists, appropriately trained surgical specialists and nurses trained in oncology. Healthcare worker skills: Weak health worker competencies attributable to inadequate training contributes to a delay in diagnosis and referral to the next level of care for definitive treatment. Stigma: Due to the stigma associated with cervical cancer, patients tend to delay seeking treatment early or even disclosing the condition.
From left: Dr Gwen Ramokgopa, First Lady Thobeka Madiba Zuma and Minister of Health Dr Aaron Motsoaledi launched the Human papilloma Virus Vaccine at Gonyane Primary in Mangaung, Free State, in 2014.