Cervical Cancer is the most common female cancer in developing countries, with approximately 500,000 new cases and 250,000 deaths each year. In Nigeria, it is the second most frequent cancer in women, after breast cancer. Around the world, a woman dies of cervical cancer every two minutes. Women in developing countries suffer disproportionately from the burden of cervical cancer and account for over 80% of cases. Ada Ezeokoli and Chioma Thomas of the Nigeria Health Watch team recently visited a cervical cancer screening project run by the Society for Family Health in Nyanya, Abuja, to learn about the work they are doing to improve the awareness and treatment of this silent killer amongst women.
Cynthia sits quietly with a group of other women at Saffron Hospital in Nyanya, an outlying annex to the city of Abuja. The women are waiting for a nurse to check their vitals and do some paperwork before being ushered into an adjoining room where a doctor and two other hospital personnel are waiting to conduct a simple screening test that will tell if a woman has changes in her cervix that may dispose her to cervical cancer (Cervical pre-cancer). Some of the women, clutching small children, look around nervously. Cynthia however is calm. She is not here to be tested. She has already been diagnosed with cervical pre-cancer and is undergoing cryotherapy treatment, which involves using a cold probe to freeze away the abnormal cells. Until recently, a service like this would not have been available to Cynthia in Nigeria.
Cervical cancer occurs most commonly in women over the age of 30 and is the second most frequent cancer among women in Nigeria after breast cancer, with an estimated 10,000 women dying of cervical cancer annually. The cancer is caused by the Human Papilloma Virus (HPV). HPV is transmitted through sex, and it can cause an infection in the cervix (the neck of the womb). The infection usually doesn’t last very long because your body can normally fight it, but an HPV infection can change cervix cells into pre-cancer cells. Most cells with early pre-cancer changes go back to normal on their own and if detected can be treated. But if they are not found and treated, the pre-cancer cells can lead to cancer.
Cervical cancer screening is a method of preventing cancer by detecting and treating early abnormalities. Early detection and treatment can prevent 75 per cent of cancers developing but, like other screening tests, it is not perfect. Early detection through screening and treatment of pre-cancerous lesions remains the best possible protection against cervical cancer. Evidence shows that utilization of screening for prevention is very poor in Nigeria (South-East, North-Central, South-West, North-West). A summary from the colposcopy unit in the antenatal clinic at the University College, Ibadan, showed that only about 3,000 women were screened in the three year period from 2005-2007.
The goal of the cervical cancer screening project is to “transform access to Cervical Cancer Screening and Preventative Therapy for millions of women worldwide, across reproductive health networks in low and middle-income countries, by integrating cervical cancer prevention and therapy with reproductive health services.” The Society for Family Health (SFH) is the recipient of a grant from the Bill and Melinda Gates Foundation to use an innovative social franchise approach to engage a network of clinics and hospitals across Nigeria in a bid to increase access to high quality clinical services for the poor and underserved clients.
SFH provides the franchise facilities with training on cervical cancer screening using the “visual inspection with acetic acid (VIA)” method. For the three facilities where women can be treated, SFH also provided the cryotheraphy machines and trained selected staff to use them. The screening facilities refer positive cases to the treatment facilities. Treatment is free for women who access the services at the facilities under the social franchise platform. Dr. Oye Tide Joseph, in charge of the Saffron Hospital Cryotheraphy unit, said he currently screens about 10 women a week, and about 8 of those 10 test negative for pre-cancer lesions.
In addition to training and equipment, SFH put in place a community-focused system on sensitization, using community volunteers called interpersonal communications conductors (IPCs). These volunteers were trained to sensitize women in the community on the need to be screened, as well as educate women of child bearing age to consider family planning and child spacing.
SFH currently works with 48 franchise facilities across Lagos, FCT, Kaduna, Enugu and Ibadan to provide cervical cancer screening. Records of these facilities show that they have screened over 10,000 women. The project has recorded 91 cases of pre-cancerous changes or early stage cancer, and 16 women have subsequently received treatment using cryotheraphy. SFH plans to provide cryotheraphy units to more facilities, train more providers on CCSPT service delivery, and scale up screening and treatment services to three more states in the future.
As a result of this project, cervical cancer screening has gained inclusion in expanded reproductive health services. Providers now encourage women to conduct a cervical examination during family planning services and other reproductive health services. In addition to the specific screening services provided, extension services are carried out into the communities around the facilities offering the services to educate people on the benefits from this service.
The CCS & PT Project is a four-year project sponsored by the Bill and Melinda Gates Foundation, with Maria Stopes International (MSI) as the principal recipient. SFH has also strengthened its partnership with the National Cancer Control Programme (NCCP) over the past few years. The NCCP developed the National Cervical Cancer Control Policy, including guidelines for private sector involvement in cervical cancer control. There is growing evidence on the effectiveness of leveraging the private sector to improve health outcomes.
For Cynthia, a horrible trajectory has been prevented. However, too many women do not yet receive the same help Cynthia did, and their health will suffer the consequences. A cervical cancer screening programme aims to reduce the number of women who develop invasive cervical cancer and the number of women who die from it. It does this by regularly screening all women at risk so that conditions which might otherwise develop into invasive cancer can be identified and treated. The evidence from many countries around the world shows that millions of lives have been saved through national cancer screening programmes. We hope that, in our lifetime, we can say the same in Nigeria.
Of all the cancers, cervical cancer is the only one that has both an effective vaccine and screening programme that can prevent disease and death. Sadly, none of these are available to Nigerian women appart from in projects such as this one by SFH. In a country as wealthy as Nigeria, this cannot possibly be accepable. While we build high speed trains, new airports and stadia, and pay legistlators millions of Naira, maybe it is time to refocus on the things that matter the most, the lives of Nigerian women.