The burden of cervical cancer is increasing and the need for concerted efforts is warranted now more than ever. We highlight the burden in Malawi and call for more efforts in cervical cancer screening and other control interventions.
Defining cervical cancer provides an entry point to our discussion. Cervical cancer is a malignant tumour of the cervix in the lower most part of the uterus and at the entrance of the uterus from the vagina.
The Human Papilloma Virus (HPV) is the predominant risk factor and therefore regarded as a cause of cervical cancer as up to 70 percent of cervical cancer cases are estimated to be caused by HPV, which is transmitted sexually.
Risk factors for HPV infection which may initiate cervical cancer include early sexual encounters as the immature cells in the cervix allow easy transmission of the HPV, having multiple sexual partners, multiple pregnancies and weak immunity due to other diseases including HIV infection.
Studies indicate that women living with HIV have a seven-fold risk of developing cervical cancer compared to their counterparts without HIV infection. Other risk factors include smoking, genetic factors and prolonged psychological stress.
Cervical cancer is commonly found in women above 30 years of age. This is mostly due to the fact that it develops over a long period of time, although it can also occur in younger women. In Malawi, up to 4.5 million women aged 15 years and above are at risk of cervical cancer. Only about 15 000 to 20 000 Malawian women utilise cervical cancer screening annually and out of these, about 4 000 women are found with cervical cancer.
Sadly, more than half of them die over the same period, making Malawi’s cancer burden the highest globally. In essence, whereas breast cancer accounts for the commonest cancer among women globally, cervical cancer accounts for the greatest cancer burden among women in Malawi.
Usually, cervical cancer has no symptoms in its early stages, but when it develops further, the affected woman experiences bleeding between periods, bleeding after sexual intercourse, bleeding in post-menopausal wome, discomfort during sexual intercourse, smelly vaginal discharge, vaginal discharge tinged with blood and pain in the pelvic region.
However, women should not reach this symptomatic stage considering that simple technologies exist to detect and control the development of cervical cancer in early stages.
In Malawi, the Ministry of Health and its partners are responding by including cervical cancer as one of its priority disease conditions whose cost-effective interventions are included in Malawi’s Essential Health Package.
At individual level, women should utilise cervical cancer screening. Women aged 21 years and above are encouraged to undergo cervical cancer screening once every three to five years and those living with HIV, every two to three years.
At community level, social and community mobilisation utilising traditional and opinion leaders is essential to reduce risk factors for cervical cancer.
With high levels of HIV prevalence in Malawi, with 56 percent of those living with HIV being women and with the close link between HIV and cervical cancer, community mobilisation efforts should also implore on women living with HIV to seek cervical cancer screening.
In addition, community members should also be mobilised to utilise other services such as Voluntary Male Medical Circumcision and HPV vaccine for girls.n