This year, Better Healthcare for Africa is working with clinical collaborators at Harvard Medical School and at St. Albert’s and other hospitals in Zimbabwe to help prevent cervical cancer. Together, we are developing, and will seek funding for, an initiative that will help these hospitals screen women for precancerous changes in the cervix and treat those changes before cancer develops.
Cervical cancer is the leading cause of cancer death for women in Zimbabwe. Nearly 1,300 Zimbabwean women died of cervical cancer in 2008, according to the latest estimates by the International Association for Cancer Research GLOBOCAN project.
Cervical cancer can be prevented if caught early through screening and treatment programs. Here are three important methods for detecting the presence of abnormal cells that are an early warning that a woman might soon develop cervical cancer:
Papanicolaou (Pap) smear
The Pap test (also called cytology-based testing) has been used for decades by high-resource countries to detect precancerous cervical cells, and it has greatly reduced the number of cervical-cancer cases in these countries. Pap tests involve gently scraping cells from the cervix, staining the cells and examining them under a microscope to see if abnormal cells are present. Pap tests involve rather expensive supplies, skilled technicians, and infrastructure for processing and evaluating cell samples and following up with patients. Also, Pap tests detect cells that might or might not become cancerous, so women must be tested repeatedly over time. These requirements make Pap tests less practical for low-resource countries.
HPV DNA test
The leading risk factor for cervical cancer is infection with the human papilloma virus (HPV). Testing cells from the cervix for the presence of DNA that belongs to HPV is proving to be the most effective way to screen women at risk for cervical cancer. At present, however, HPV DNA testing is too expensive for low-resource countries.
Visual inspection with acetic acid (VIA)
This is the simplest and most economical way to detect the abnormal cells that warn of cervical cancer. In brief, very dilute acetic acid (3 to 5 percent, like vinegar) is applied to the cervix, and the solution turns abnormal cervical cells white. These white, precanerous cells can be seen by visually examining the cervix. According to the Alliance for Cervical Cancer Prevention (ACCP), “Until low-cost HPV DNA testing becomes more widely available for developing countries, visual inspection methods, especially VIA, provide reliable and effective means for reducing the burden of cervical cancer.”
Treatment – Cryotherapy
Cryotherapy is a technology that kills pre-cancerous cervical cells by freezing them. The ACCP has concluded that cryotherapy offers a safe, effective, and simple means of treating women with precancerous cervical cells. And it is affordable in low-resource settings.
The Need for Cervical Cancer Screening in Zimbabwe
Currently, cervical cancer early detection and treatment are largely unavailable to women in Zimbabwe. One Zimbabwean physician, who is not connected with St. Albert’s, described the situation this way:
It is of great importance to detect cervical cancer early to reduce the burden, but the main problem here is that most cases we see are [at the] end stage of the disease (stage 4 cervical cancer). We also don’t know much about cryotherapy nor VIA, and we have no capacity to test for HPV DNA.
Basically, apart from physical examination, a speculum exam is done and a punch biopsy is done to confirm the diagnosis. The results come in after about 10 days, and, if cancer is confirmed histologically, the patient is referred to Parirenyatwa Hospital for radiotherapy. But most of these patients are financially constrained; thus, they cannot travel to Parirenyatwa in Harare, the only centre with radiotherapy machines, though most of the time the machines are down (they are old machines), and the queue is long.
Women with advanced cervical cancer who cannot travel to Parirenyatwa Hospital simply return home to die. Little palliative care is available, the doctor said. (Palliative care is designed to control pain and to comfort a dying person.)
As for palliative care, we don’t have morphine for pain, and most of the patients cannot be followed-up because they come from far away areas. It is probable that most of these patients die at home from complications of cancer (anaemia, renal failure, fistulas of the bladder or rectum). At our hospital, we can transfuse anaemic patients if blood is available, though it is often in short supply and it is expensive. We can supply simple pain-killers.
As a first step in our cervical-cancer prevention efforts, BHA in mid-January provided St. Albert’s with funds to purchase nitrous oxide, which the hospital will use as a refrigerant for cryotherapy for treating women with precancerous cells in the cervix.
We will keep you informed here about the problem of cervical cancer in Zimbabwe and our efforts to ease the suffering it causes. Please note that you can become a part of this and our other efforts with a financial contribution to BHA.