Survey reveals lack of knowledge puts many women at risk of cervical cancer

As Kenya joins the world in marking World Cancer Day on Saturday, a new survey has revealed that majority of Kenyan women are not aware of the main cause of cervical cancer, despite the disease being a top killer.

The survey, involving women in Kenya’s major cities of Nairobi, Mombasa and Kisumu indicates that 97 per cent are not aware of the Human Papilloma Virus (HPV) - the sexually transmitted virus that has been established to cause virtually all cases of cervical cancer.

Instead, the survey reveals widespread misconceptions about the causes of the disease with many women attributing it to frequent abortions.

The survey, conducted in October 2016, was commissioned by Lancet Group of Labs and Alison Productions, and was conducted by the research firm Consumer Options Limited. It involved 327 women in the three cities aged 18 to 60 years.

“We initiated the survey to improve our cervical cancer screening programme with the view to save more women from the disease,” said Dr Ahmed Kalebi, Consultant Pathologist and Group MD/CEO of Lancet Group of Labs.

He added “However, the low levels of awareness about HPV in general and of HPV as the cause of cervical cancer was a shocking surprise and a great concern, hence the reason for sharing some of these findings from our survey on World Cancer Day.”

Dr Kalebi said the fact that less than 5 per cent of women know about the link between HPV and Cervical Cancer should be a wake-up call to all stakeholders.

He said the level of awareness about HPV would even be much lower in rural areas where the literacy levels and access to information are lower.

“Not knowing that HPV causes cervical cancer is like not knowing that HIV causes AIDS. Just like HIV testing is done to identify those infected before they progress to the stage of immunodeficiency, so should HPV be tested before women progress to pre-cancerous and cancer stages, because once identified as positive, someone can be treated,” explains Dr Kalebi.

Testing for HPV is emerging as a recommended method of screening for cervical cancer compared to the traditional methods of pap smear and visual inspection as it identifies the high-risk virus that causes the disease.

A recently-introduced HPV testing programme at Lancet labs found 8 per cent of women tested to be positive for high-risk HPV, while 91 per cent were negative. Studies done in Kenya and worldwide show a prevalence of 5% - 20% for high-risk HPV.

The screening programme also gives women the option of collecting samples for testing by themselves using a special brush to save them the embarrassment of exposing their private parts to health personnel.

HPV is spread sexually and women are infected with it at one time or another in their lives, especially during their sexual debut.

Whereas in the majority of women, the immune system clears away HPV naturally, for a small percentage, the virus persists in the cervix leading to cellular changes in the cervical cells that progresses over 5-15 years to become cancerous. And eventually manifesting as cervical cancer.

There are many sub-types of HPV but 14 sub-types are known to high-risk especially HPV type 16 and HPV type 18 which account for 70% of cervical cancer cases, while the other 12 sub-types account for 30%.

A recent guideline issued by a global team under the auspices of the American Society for Clinical Oncology (ASCO) in October 2016 now recommends HPV testing as the primary screening tool of choice for cervical cancer instead of pap smear and visual inspection with acetic acid (VIA).

Previously in 2013, the World Health Organization (WHO) had also issued guidelines on cervical cancer screening, in which HPV Testing was recognized as a preferred method for cervical cancer screening programs.

The new ASCO global guidelines recommend that in low-resource settings, women may be screened one to three times in their lifetimes, but resources permitting, it can be done every 5 to 10 years.

Governments, including those of United Kingdom, Netherlands, Australia and New Zealand have switched from pap smear to HPV testing in their national cancer screening programmes, while Australia was the first to incorporate self-collected samples as part of the government programme.

According to Kenya’s Ministry of Health, cervical cancer is the second most common cancer among Kenyan women and in terms of deaths, it is top most. This however should not be the case as cervical cancer is the only cancer that is totally preventable.

 At least 2,454 women are diagnosed with it every year in Kenya while at least 1,676 die from it. It is 10 times more prevalent in Kenya than in the United States.