Management of Cervical cancer in Kenya as a public health concern: what you need to know

By Sophie Nyongesa

Cervical cancer is the second common cancer in women in Kenya after breast cancer. The global cancer observatory through the International agency for Research on Cancer (IARC) shows that in 2020, there were 5, 236 (19.7%) new cases of cervical cancer in women of all ages in Kenya, ranking second after breast cancer with 6,799 (25.6%) of new cases. Unfortunately, cervical cancer registered 3, 211 deaths the same year, having ranked first with the highest number of deaths followed by breast cancer (3,107). Moreover, the 5-year prevalence of cervical cancer among women of all ages was 10,881.

The World Health Organization points out that cervical cancer mortality rates in most developing countries have risen or remain unchanged during the past 30 years, often due to limited access to health services, lack of awareness and absence of screening and treatment programmes. Rural and poorer women living in low- and middle-income countries, as well as poorer women living in high-income countries are at an increased risk of invasive cervical cancer, because they often do not have access to crucial prevention, screening and treatment services.

According to World Health Organization almost all cervical cancer cases (99%) are linked to infection with high-risk Human Papilloma Virus (HPV), an extremely common virus transmitted through sexual contact. Although most infections with HPV resolve spontaneously and cause no symptoms, persistent infection can cause cervical cancer in women.

Sexual violence plays a critical role in the development of cervical cancer. Women who are forced into sexual activities in childhood and adulthood are at an increased risk of developing STIs, including HPV infection. Persistent high risk HPVs are necessary etiological agent for causing cervical cancer. Ending sexual violence against women as well use of contraceptives such as condoms during sexual intercourse can play a critical role in reducing the risk of contracting STIs such as HPV, thus decreasing the probability of developing cervical cancer. The WHO states that upholding of sexual and reproductive health rights is a global strategy towards elimination of cervical cancer as a public health problem.

To tackle cervical cancer effectively, WHO outlines that screening programmes have a vital role in cervical cancer prevention allowing for early detection and treatment. When diagnosed, cervical cancer is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively. Screening followed by adequate treatment is recommended for every woman aged 30, every 5 to 10 years if the screening test is negative and depending on the screening test used. WHO also recommends that countries ensure that women from 30 to 49 years are screened at least once in their lifetime.

Another strategy to effectively tackle cervical cancer is the HPV vaccine. There exists a safe and effective HPV vaccine which when provided to young girls between 9 and 13 years old protects against HPV, and therefore against cervical cancer. The World Health Organization shows that all the three HPV vaccines (bivalent, quadrivalent and a monovalent vaccine) are highly efficacious in preventing infection with virus types 16 and 18, which are together responsible for approximately 70% of cervical cancer cases globally. Moreover, since HPV is a Sexually Transmitted Infection, use of protection such as condoms during sexual intercourse can help prevent its transmission thus reducing the risk for cervical cancer.

The World Health Organization reiterates its recommendation that HPV vaccines should be included in the national immunizations programmes, provided that the prevention of cervical cancer and other HPV related diseases constitutes a public health priority.

Cervical cancer is a highly preventable and treatable type of cancer if all measures from screening programmes, HPV vaccination to early and effective treatments are put in place.  Clear and sustained communication, robust advocacy, and strategic partnerships are needed to inspire national governments and international bodies to action, including identifying and allocating sustainable resources towards cervical cancer programs.

With a comprehensive and robust approach to prevent, screen and treat cervical cancer can be eliminated as a public health problem within a generation!





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