Jane Mworia was diagnosed with cervical cancer late last year and happens to be one of four to ten women in Kenya diagnosed with cancer each week at Kenyatta National Hospital (KNH).

She recalls that one day after a busy week recently took a nap, but when she stood up a lot of blood started streaming down her legs.

Most women, like Jane, only find out they are carrying the number two cancer killer world-wide when it is already too late. Cervical cancer usually progresses in four stages. Cervical cancer is caused by a group of viruses collectively known as human papilloma viruses (HPV) and although there are a hundred of them, only a few of them are known as high risk . 

Cervical infection develops into cancerous lesions which develop into cancer and the whole process can take about 20years or more. The first stage is termed the early stage and has almost no symptoms but by the second stage a woman may experience abnormal vaginal discharge, bleeding in between periods and heavy bleeding during periods. 

Primary prevention measures against cervical cancer include delayed sexual activity and vaccination. Currently, there are two types of vaccines; quadrivalent which can handle four types of (HPV) and bivalent which handles two types of HPV.  However, only quadrivalent is available in Kenya. 

The quadrivalent vaccine is taken in three doses and one dose costs about KSh 6,600 (US $100). 

Developing countries are more stricken than the developed, according to the Global Call to Stop Cervical Cancer, a movement committed to raising awareness and to provoke action against the killer cancer, of the 250million who die from cervical cancer worldwide, 80 percent are women in developing countries. 

Even with the global cancer advocacy in the last five years to make a cervical cancer vaccine available for women in developing countries many women are unaware that the condition is preventable if they took the necessary precautions. 

‘’A pap smear takes only a minute, is reasonably affordable compared to how much it would cost you to undergo a radiotherapy treatment, and is pain free,” said Dr.Omondi Ogutu, the chair of the Kenya Obstetrical and Gynaecological Society.
 

His medical colleagues, Dr Nelly Rwamba Mugo and Dr Emma Karari agree with Dr Ogutu but add that most women detest having pelvic examinations conducted on them because of the intrusive procedures involved, and this leads to delays in seeking treatment. 

“Women don’t want to expose themselves ‘unnecessarily’. They assume all is well as long as they feel healthy and only rush to the hospital at the eleventh hour,’’ says Dr Karari. 

“By the time they check into hospital, the cancer is so advanced and the cost devastating,”says Dr Mugo, “Yet a simple annual pap smear test is the best preventive measure because it catches the cancer when it can still be treated.” 

At KNH, a pap smear test costs between KSh 150 to KSh 200, while radiotherapy costs between KSh 30,000 to KSh 40,000. Beside the monetary cost, the patient must also undergo the discomfort of bleeding, fever, persistent pain and general ill health. 

“We have only one radiotherapy unit at KNH for cancer treatments, besides the wait list, the patients are required to book in advance, then be admitted for about 30 days to undergo radiotherapy,” says Dr Mugo. 

Since all these services are centralized in Nairobi, the cost for patients coming in from other parts of Kenya becomes prohibitive when they factor in travel and accommodation costs. 

Recently in Nairobi, at the International Women’s Summit on HIV and AIDS organized by the World Young Women’s Christian Association (YWCA), discussed the disturbing link between cervical cancer and HIV/AIDS. 

Experts have consistently pointed out that sexually active women are more at risk of contracting both cervical cancer and HIV/AIDS. The risk is higher in sexually active women who are also HIV positive.  An estimated 70 percent of women living with HIV will also have cervical cancer. 

HIV positive women are believed to be about four times more likely to develop the pre-cancerous lesions that can lead to cervical cancer than HIV negative women. 

“HIV reduces your immunity which makes it easy for HPV to shift cellular growth from normal to abnormal,” explains Dr Ogutu.  He cautions that cervical cancer can develop rapidly. 

For Sister Hilder, a religious nun from Nigeria who attended the Summit, the medics’ words do not begin to describe her daily experiences with women suffering from cervical cancer and other complications. 

 “You see them in pain, bleeding and smelling and there is nothing you can do to help,” says the nun who has lost five patients on the way to the hospital. 

However, the meeting raised concerns about meeting the needs of women with disability, and especially women with hearing impairment who tend to be left out of life-saving campaigns. 

Judith Mahindu, a Kenyan woman living with hearing impairment said there was little information on HIV/AIDS and cancer for women with her disability:  “Teach deaf people about HIV and cancer, and include us in the information campaigns – especially about reproductive health issues,” she emphasized. 

According to the World Health Organisation, globally cervical cancer claims the lives of an estimated 500,000 women annually.  Medical practitioners recommend one pap smear annually as the ideal preventive measure and when that is not possible at least one in two years. 

Although the burden of seeking preventive measures and treatment rests with women, the meeting emphasized that men had a crucial role in the fight against cervical cancer, by offering financial and moral support to their partners’ as well practicing responsible sexual behaviour.