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Friday, October 15, 2021

Cervical cancer screening: A review

By Malamin Barrow

Clinical Cytologist

Healthscreen Diagnostic Lab

Brusubi, WCR.

Cervical Cancer is a global public health problem specific to women, with a worldwide incidence in excess of half a million (500,000) cases annually, resulting in the deaths of approximately three hundred thousand (300,000) women globally. Underlying this grim statistics is an iniquitous distribution that is based on the economic health of nation states. The region described as sub-Saharan Africa is said to have the highest prevalence of precancerous and cancerous lesions of the cervix, and also the highest death rate from Cervical Cancer. Sub-regionally, Gambia and Senegal included, Cervical Cancer is in the first or second category of cancer deaths among women.

 What is it?

The cervix is the neck of the womb, sometimes described as the entrance to the uterus (womb). Almost all healthcare providers in the country are aware of the basic anatomy of the cervix and the related health problems that affect it. Cervical cancer happens when cells lining the inner surface of the cervix become abnormal and grow uncontrollably. Human papilloma Virus (HPV) is the necessary cause of Cervical Cancer. HPV is a common virus, 8 in10 men or women are said to carry the virus at some point in their life. In the majority of cases, the immune system will clear the virus within 1-2 years. However, a minority of people will continue to harbour the virus leading to Cervical Cancer. Hence the need to screen women for HPV infection, and cellular changes that might lead to Cancer.

Symptoms and risk factors

Symptoms of Cervical Cancer may not be obvious, especially in the early stages. In the absence of a nationally mandated Cervical Cancer Screening program, it is important that women consult their healthcare provider if they observe any of the following symptoms. A) Unusual Vaginal bleeding experienced during or after sex, between periods, or after menopause. B) Changes in Vaginal discharge colour, smell, or consistency. C) Pain or discomfort during sex. D) Unexplained lower back pain. It should be noted that these symptoms may be caused by other reasons unrelated to cervical cancer. However, cervical health screening will be helpful to your doctor in differential diagnostic decision making.

There are risk factors associated with Cervical cancer, which include: A) HIV and other immunosuppressive condition. B) Start of sexual intercourse at an early age. C) Multiple sex partners or partners with multiple sex partners. D) Smoking. E) Long term use of oral contraceptives.

Cervical Health Screening

Methods for detecting Cervical Cancer have evolved over the years. The PAP smear test introduced in the 1940s by Georgios Papaniklaou for detecting cancerous or precancerous lesions of the cervix has been the standard screening method.  Other screening methods including visual examination of the cervix (VIA), and Molecular detection of High risk HPV (HrHPV) have been used as screening strategies by different health services.  Since the introduction of the PAP smear test, many advanced healthcare systems have provided cervical cancer screening to their population, and have succeeded in reducing cervical deaths by about 75%. The majority of cervical cancer deaths (80%) are recorded in low income countries, whose fragile care systems are not equipped for Cervical Health Screening. This is rather unfortunate, because cervical health screening has been one of most successful cancer prevention tools. Generally, the available screening tests are easy to perform, and are reasonably accurate in detecting precancerous lesion of the cervix.

CURRENT NATIONAL SITUATION.

The burden of cervical morbidity and mortality is recognized by The Gambia’s Ministry of Health and Social Welfare (MOHSW). Under the national health strategic policy 2014-2020, the prevention and control of non communicable diseases including cervical cancer features prominently. However, implementation challenges have meant that a comprehensive national Cervical Cancer Screening program has not yet been rolled out. Multiple cancer advocacy groups have been doing their utmost to educate and help target groups to be aware of the disease and to seek help.

At Healthscreen Diagnostic Lab, we have been liaising with prominent local Gynaecologist in the country since 2018 to provide PAP Smear based Cervical Cancer Screening service. Though important, this intervention can only be a drop in the ocean, as it were, in the overall national prevention of cervical cancer.  It is also understood that there is an ongoing pilot HPV vaccination program aimed at immunizing young girls against developing cervical cancer.

Conclusion:

Cervical Cancer is a preventable illness that requires the whole hearted intervention of National Health Authorities to protect women from the devastating consequences a condition which can be easily detected in it’s early stages, and relatively cheap to treat. Screening and treatment can be made available at almost every healthcare facility, which will result in a sharp decline in the rate of women dying from the number one cause of Cancer deaths among women in the country. Advocacy groups have an important role in education and sensitization, which if combined with robust clinical and scientific support by the health authorities, can lead to the eradication of Cervical Cancer in the Country.

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