Did you know that Cervical cancer is the leading cause of cancer death in women in Kenya? The saddest thing about cervical cancer is that it robs the lives of women who are in their prime. Most cervical cancer patients are diagnosed between age 35 to 45.
A time when they are busy raising their children, and likely approaching peak performance in their careers. Cervical cancer robs children of the mothers, husbands of their wives, and women in the prime of their careers.
Did you know that compared to other cancers, cervical cancer is almost 100% preventable? In today’s world and with modern science no woman should die from cervical cancer. Please do not be a victim. Do not wait for symptoms of pain and abnormal bleeding because by then cervical cancer is at an advanced stage. Take charge of your life and health in the following ways
Vaccination
Did you know that cervical cancer can be prevented by vaccination? Yes, just as the hepatitis B vaccine can prevent liver cancer, the HPV vaccine can prevent Cervical cancer. HPV, the Human papillomavirus is responsible for almost 100% of cervical cancers. The vaccine provides immunity against the most common high-risk strains of HPV that cause cervical cancer.
Like any other vaccine, it works best for women who have not been exposed to HPV. HPV is a virus that is spread by intimate activities and is highly contagious during sexual activities. Transmission is also not completely prevented with condoms as it affects skin surfaces. Thus the HPV vaccine is primarily recommended for girls and teenagers aged 10 to 15. It is available at most government clinics for this age group. Many older women may not have been sexually active or exposed, thus women are eligible for this vaccine up to age 45.
Screening tests
Screening tests are advised in all women, even those who have been vaccinated from age 25 to 65. It is important to understand that the main purpose of a screening test is to detect abnormal cells and treat them BEFORE they progress to cancer. Treatment of these abnormal cells is simple and lifesaving. After treatment, women will still have periods, have a normal sexual life, carry pregnancies, and can have normal vaginal deliveries. There are 4 main ways of screening for cervical cancer in Kenya
HPV testing
HPV testing is now advocated as the primary (most advised) method by the Kenya Ministry of Health as well as most international bodies such as the World Health Organization among others. HPV testing tests for high-risk HPV strains. The advantage of the HPV test is that it is the most sensitive (accurate). Also if your test is negative, you can have your next test in 5 years. Another great advantage is that you do not necessarily have to undergo an invasive speculum examination by a doctor or health care provider. Patients can swab themselves in the privacy of their homes or in a restroom at the lab/clinic. This is as accurate as an invasive test by a healthcare provider. So please do not avoid HPV testing because of fear of an intimate exam. HPV testing is advised for women above 30 years of age
Pap smear test
A pap smear is probably the most known of all the methods. Pap smear was first reported in 1928 and came into widespread use in 1941. In those countries where routine pap smears were advocated for and supported by public health financing and infrastructure, cervical cancer is almost unheard of. Pap smears should be done at least every 3 years as they are not as accurate as the HPV test. Pap smears alone are the recommended test for women aged 25-30.
Pap smear and HPV co-test
The HPV and pap smear co-test is recommended for women between the ages of 30 to 65. If both are negative, then testing can be done every 5 years. The advantage of the test is that the pap smear will advise if there are any abnormal cells and the HPV test will advise if there is any high-risk infection.
VIA/VILI testing
Visual inspection with acetic acid and/or Lugols commonly known as VIA/VILI testing. In this procedure, a healthcare worker examines the cervix with a speculum using acetic acid commonly known as vinegar. This is the primary screening modality in low-resource areas as it is cheap and does not require a laboratory. Also, any abnormality can be visualized immediately and treatment offered at the same clinic visit. It is as sensitive as pap smears. The main drawback is that it is user-dependent. Some women may undergo unnecessary treatment. However, it is very accurate for identifying abnormal lesions.
Please note that women whose immunity may be compromised such as those living with HIV, Lupus, and Kidney failure are advised to do screening tests every year. Women who have had a hysterectomy where their cervix was removed do not need cervical cancer screening unless they have a history of highly abnormal pap smears or cervical cancer.
Cervical cancer screening may be stopped at age 65 if all previous regular screenings have been normal. However, it may continue past age 65 for those who may have had a previous abnormal pap smear or may have a new sexual partner.
So there are many ways of preventing this terrible disease. Please get your daughters and young sisters vaccinated. Engage in regular screening and save your life.
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By Dr Patricia Muthaura, Consultant Obstetrician and Gynaecologist at Aga Khan University Hospital, Nairobi
