CERVICAL CANCER AWARENESS MONTH

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‘’There can be no Universal Health Care without sexual and reproductive health care.’’ Dr. Natalia Kanem, UNFPA Executive Director.

January is globally recognized as Cervical Cancer Awareness Month, symbolized by a teal-colored ribbon. Cervical cancer ranks as the fourth most prevalent cancer among women worldwide and ranks second for female-related cancers in Ghana. Despite its global impact, cervical cancer is treatable when detected early, and more than half of diagnosed cases result in fatalities annually.

In 2020 alone, there were 604,000 new cases of cervical cancer globally, leading to the unfortunate demise of 342,000 women. Notably, 90% of these deaths occurred in low and middle-income countries, emphasizing the urgent need for awareness and early detection. In Ghana, 2,767 new cases were recorded in 2020 with 1,699 deaths.

According to the World Health Organization (WHO), women living with HIV face a sixfold higher risk of developing cervical cancer. There are also 10.6 million women in Ghana within the 15–45-year age group (Women In Fertility Age, WIFA) who face a high risk of developing cervical cancer.

The global theme for 2024 Cervical Cancer Awareness Month is “LEARN, PREVENT, SCREEN.”

Cervical cancer originates in the cervix, the lower part of the uterus, with Human Papillomavirus (HPV) identified as its primary cause. Although the immune system naturally clears HPV infections, persistent infections with high-risk types 16 and 18, often lead to the development of abnormal cells, progressing to cancer over time.

These high-risk HPV types are responsible for 70% of all cervical cancers. The progression of cervical cancer is slow, taking 15-20 years for abnormal cells to develop into cancer. However, immune-suppressed women face a 10-year reduction in this timeframe, resulting in a 5–10-year cancer progression period.

CATHERINE JANE BAIDOO (MIDWIFERY OFFICER)
KAWUSAR MOHAMMED(NURSING OFFICER)

Risk Factors

  • Early age of sexual activities
  • Having multiple sexual partners
  • Immune suppression
  • Increased number of births

Causes:

  • Persistent HPV infection
  • Engaging in sexual contact with an infected individual

Prevention:

  • Vaccination for girls aged 9-14 years.
  • Screening starting at age 30 or at any age when symptoms may be present
  • Condom use

Screening Options:

  • Visual Inspection with Acetic Acid (VIA): involves the application of acetic acid to the cervix to look for changes.
  • Pap smear test: samples of cells of the cervix are taken using a spatula and brush.
  • HPV test: this can be taken by a healthcare provider or the woman with a swab

Treatment Of Pre-Cancerous Cells:

  • Thermal ablation
  • LEETZ (large loop excision of the transformational zone)
  • Cryotherapy
  • Cold knife conization

Our Efforts:

The Tain District Hospital is a facility that serves as a referral center and provides care to a significant population of 149,848 residents in the Tain and Banda Districts. There are 35,770 women in the WIFA group in these districts and thus are at risk of cervical cancer. In the last five years, however, only four cases were detected. Arguably, this can be attributed to low screening for precancerous and cancerous lesions in the district. This has prompted the establishment of the Cervical Cancer and Female Schisto Project (CERVASHIP) Center in the facility for the screening of cervical cancer and female genital schistosomiasis (FGS).

The CERVASHIP Center was established in September 2023, through the inspiration and guidance of the Center for Research and Applied Biology (CeRAB) of the University of Energy and Natural Resources (UENR), Sunyani, led by Dr. Emmanuel Timmy Donkoh. Since its establishment, the center has screened over 300 women for cervical cancer and female genital schistosomiasis using Visual Inspection with Acetic acid (VIA), Human papillomavirus (HPV) DNA tests, and PCR tests for Schistosoma ova detection. Detectedcases are promptly linked to care. However, the center faces challenges with late-stage presentations of these cancers.

To enhance screening accessibility, the CERVASHIP center conducts mobile screenings at health facilities and trains health workers to provide these essential services. A significant obstacle the center faces is the lack of equipment for treating the screened positive cases. The screen-and-treat approach has proven effective in low-resource settings and could be instrumental if adequate treatment equipment becomes available.

The World Health Organization (WHO) aims to eliminate cervical cancer by 2030 through the Global Strategy, which includes:

  • Vaccinating 90% of girls by age 15
  • Screening 70% of women aged 35-45
  • Ensuring 90% of women with the disease receive treatment.

To support these goals, our center is collaborating with Screen and Treat Organization to offer free screening in selected communities within the Tain district. It is also partnering with Ante Retroviral Therapy clinic to screen female clients.https://taindistricthospital.com/blog/

REFERENCES

  1. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
  2. National Cancer Institute: https://www.cancer.gov/types/cervical
  3. Global Cancer Observatory: International Agency for Research on Cancer; https://gco.iarc.fr/
  4. Global Health eLearning Center: Cervical Cancer Prevention (low resource setting)

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