Cancer of the Cervix in Kigumo
I was sad to encounter a woman with late-stage cancer of the cervix in the Kigumo area of Murang’a County early on this year. In this day and age, this should not be happening. This lady had never had any form of cervical screening. Her last encounter with examination was delivery of her last child who is now over ten years old.
My role as a gynaecologist in preventing late-stage cervical cancer
As an obstetrician and gynaecologist, I feel that I owe this lady an apology and a pathway to treatment.
Pathway to treatment
I took a thorough history, examined her, did some laboratory tests on her and did examination under anaesthesia, staged the cervical cancer to help determine how her treatment will proceed and took a biopsy of the cervical growth and sent it to the pathologist for histology i.e. for the pathologist to tell us what type of cancerous cells are these so that we know how to treat it. Different histological types have different ways of treating them. There are some that do not for instance respond to radiotherapy while other histological types do not respond to chemotherapy. I then referred her to the gynae-oncologists at KUTTRH to complete the treatment cycle.
Steps for Kenya to #EndCervicalCancer
My policy proposal on the steps Kenya needs to eliminate cancer of the cervix.
To succeed Kenya will need a combination of:
– Organized public health policies
– Early detection strategies, and
– Strong healthcare systems.
The key elements of this will include:
1. Nationwide, Organized Screening Programs
– Cytology (Pap smear) screening
• Screening should be population-based (not opportunistic).
– Invitations should be sent to eligible women.
– Reminders should be sent for non-attenders.
– Central registries should be established to track participation.
• Target coverage rates of 70–90% of women in target age groups.
• Screening intervals be standardized (every 3–5 years)
• Early detection will greatly reduce advanced disease at diagnosis.
2. Comprehensive Cancer Registries
• Establish national cancer registries to monitor incidence, mortality, and screening coverage.
• Continuous evaluation and quality improvement, identifying gaps in participation or follow-up.
3. Follow-up and Management Systems
• Abnormal smear results should trigger organized follow-up, with referral to colposcopy and treatment.
• Establish systems to minimize “loss to follow-up,” which is a common cause of progression to late-stage disease in weaker health systems.
4. Equitable Access to Care
• Universal healthcare should be strengthened to ensure that all women can access screening and treatment at little or no cost.
• This will reduce disparities by socioeconomic status, which is a major barrier to access to screening and treatment.
5. Public Health Education and Awareness
• Establish continuous public campaigns promoted screening uptake.
• Frontline health workforce should be encouraged to motivate women to attend screening programs.
6. HPV Vaccination
• Adopting HPV vaccination for girls and l boys.
• A high coverage rate in school-based programs would lead to a decline in cervical cancer and especially in late-stage disease in the future.
7. Shift to HPV-Based Screening
In future Kenya would then move from cytology to HPV primary screening, which is more sensitive and catches precancerous lesions earlier.
Conclusion
An organized, population-based screening + registry tracking + equitable healthcare + HPV vaccination will lead to a minimization of the late-stage cervical cancer that I managed in Murang’a County recently.
Together, let us #EndCervicalCancer.
Dr Simon Kigondu is an obstetrician gynaecologist at Excella Healthcare