Early detection: Lucy's cervical cancer journey and key lessons for you

Lucy Lorna at her home in Embu.[Courtesy] She took a deep breath in, and another to exhale the anxiety. Her emotions were heightened as she waited for the doctor to see her. The music on screen in the waiting room was occasionally broken by a news item from the television on the wall, amplifying her nervous moments. For nearly two years, she had thought that the discharge would go away and eventually resume her regular menstrual cycle. But it didn't. The abdominal discomfort had increased. "I was using at least three sanitary packets daily. One day, I went to the bathroom and the heavy brownish discharge scared me. I was really scared. I booked to see the doctor," she said, describing the pivotal moment that spurred her to seek medical attention. The doctor did not tell her outright that she had cancer. When test results showed she had early stage cervical cancer, her world caved-in. She was diagnosed with cervical cancer in 2023."The doctor shared his initial suspicions and after a second confirmatory test, told me to update my NHIF account. I was lost. Cancer. The doctor referred me for a few counselling sessions then we drew a treatment plan," she recalls. Her mind raced back to her two children, going through possibilities of their health, wellbeing, education, each scenario worse than the last. But the doctors gave her hope that if she began treatment within good timing, the condition would be best managed. "The biopsy showed I had cervical cancer at stage 1B, and referred to Kenyatta National Hospital to begin treatment. A friend suggested Kenyatta University Teaching and Referral Hospital (KUTRH) and that's where my treatment journey began," she adds. The worrisome and emotionally draining days are now behind her. Today, Lucy Lorna, a 51-year-old mother of two, is an advocate for early screening for cervical cancer for all women of reproductive age, sharing her journey as a survivor and champion. Lorna then booked an appointment at KUTRH, for an MRI, which showed her cancer was at stage 2B, as opposed to what the biopsy had shown. She began treatment with three chemotherapy sessions, getting one every three weeks, with a break of six weeks before proceeding to radiotherapy, where she had 25 sessions, followed by five chemotherapy sessions and thereafter, brachytherapy. A CT scan and MRI scan that she did after the first phase of treatment indicated that the cancer had reduced by 59 per cent, and she was given a break of four months before going for further screening. Currently, Lorna is waiting for a PET scan that would guide the next course of treatment, to be done in early March this year. Lorna's experience reflects the broader picture of cervical cancer in Kenya and globally. The World Health Organisation (WHO) identifies cervical cancer as the fourth most common cancer in women globally. Data from WHO indicates that in 2022, there were about 660,000 new cases of cervical cancer and 350,000 deaths globally, where 94 percent of deaths from cervical cancer in 2022 occurred in low- and middle-income countries, with the highest rates in Sub-Saharan Africa, Central America, and South-East Asia. It also indicated that cervical cancer is the leading cause of cancer-related death in women in Eastern, Western, Middle, and Southern Africa. In Kenya, cervical cancer is the second most common cancer and leading cause of cancer-related deaths. According to GLOBOCAN data, in 2020, there were 5,236 new cases and 3,211 deaths from cervical cancer in Kenya, with an estimated incidence of 40.1 cases per 100,000 women per year. Dr Alfred Mokomba, an oncological gynecologist, says cervical cancer is mainly caused by Human Papilloma Virus (HPV) 16 and 18 and can be a sexually transmitted disease. "Those with risky sexual behaviours, such as having many partners, those with a partner who has many partners, those with low immunity, such as people with HIV, those who engage in commercial sex, and those who get frequent sexually transmitted infections like gonorrhea and chlamydia are at risk of getting HPV and subsequently cervical cancer," he outlines several risk factors. He also says girls who start sexual activity early are at a higher risk of contracting HPV because, below 18 years, the lining of the genital tract is not mature enough to fight off sexually transmitted infections. Dr Mokomba says in the initial stages, cervical cancer may not have any symptoms, which is why many women may not go for screening and only show up when the cancer has advanced. This lack of early warning signs makes regular screening crucial. "Some women will visit the hospital when they have abnormal vaginal bleeding, watery foul-smelling vaginal discharge, pain during intercourse, bleeding after intercourse, abdominal pains, and when advanced, some women present with urine and stool incontinence because the cancer forms a fistula, which leads to incontinence in the late stages," he further explains. Diagnosis of cervical cancer involves several procedures. Dr Mokomba says diagnosis is done through pap smears, HPV testing and speculum examination where one can visualise the cervix and tell whether there is a problem or not. This is followed by a biopsy in cases where the doctor detects an abnormality which is taking a small bite of tissue from the cervix and subject it to laboratory analysis. Further, he explains that colposcopy is also conducted for those with abnormalities in the pap smear, which is done by looking at the cervix using a microscope to see abnormal areas and take specimens for laboratory analysis. According to Dr Diana Wangeshi, a Rotary Club of Nyeri member and a lecturer with a background in nursing, encouraging early screening for cervical cancer is one of the most effective ways of working towards higher rates of effective treatment and management. "I have been visiting women's groups and giving talks on cervical cancer, sharing information on the need to take a Pap smear, how to check their discharge or any abnormal thing in their womanhood, and seek medical attention any time they find an abnormality," she says. In her PhD research, investigated the low cervical cancer burden in Western countries, which is tied to robust prevention, treatment and management policies and programmes. Dr Njuguna studied the WHO guidelines on the prevention, treatment, and management of cervical cancer, with a focus on East African countries, including Kenya, Rwanda, Uganda, Tanzania, Ethiopia, Eritrea, Djibouti, Somalia, Madagascar, DRC Congo, and Burundi, and found that, apart from Somalia and Djibouti, all the other countries had policies on cervical cancer with little or no implementation. She also found out that there is limited data on who is affected or who is not, and what is available is estimated data from GLOBOCAN; therefore, she recommends that we can make use of hospital-based cancer registries rather than one repository. "The government needs to work with people on the ground so that, as they come up with policies, they have tangible data, so that they can know what will work and what will not work," she said. The Rotary Foundation has awarded more than $10.3 million in global grant funding for cervical cancer projects globally since 2014 grants to evidence-based programs that align with at least one of Rotary's causes and are ready for expansion to create larger-scale change. The United to End Cervical Cancer in Egypt was awarded two million dollars as part of the third annual Programs of Scale competition in the four-year program in and around Cairo to vaccinate more than 30,000 girls ages 9 to 15 to prevent infection with the human papillomavirus, which causes the disease. HPV vaccinations before a young person becomes sexually active can prevent infection, and therefore cervical cancer. For Lorna, the illness was a chance for her to grow her heart and walk with others in the same situation especially the early difficult days of diagnosis and treatment. She shares her journey-the struggles, joys and the victories. "I want to reach out with real empathy, because I have been in a similar situation hurting and unsure what lies ahead in the journey of tests and treatments," she said.

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