Cervical cancer ravages women despite availability of HPV vaccine

A visit to any private or public hospital reveals a sad state of affairs. Many women are in the throes of their lives as the last stages of cervical cancer wreak havoc.

Kenya has one of the highest rates globally, with 40 new cases of cervical cancer diagnosed per 100,000 women annually. A health survey conducted towards the end of 2020 shows cervical cancer as the second most common cancer, after breast cancer, and the leading cause of cancer related deaths among women in Kenya, contributing to 5,336 new cases and 3,211 deaths annually.

Molecular techniques have enabled medical science to characterise the group of viruses, human papillomaviruses (HPV) that cause warts, including anogenital warts and related anogenital cancers, and their precursor lesions. Cancer of the uterine cervix is one of the cancers now known to be 100 percent related to (HPV).

“This is the second most common cancer among women worldwide after breast cancer and number one killer of women in in developing countries like Kenya”, says Professor Nelly Mugo, a consultant and research scientist with Kenya Medical Research Institute (KEMRI).

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Many cases are diagnosed throughout the world with deaths of women aged between 30 to 60 years being reported.

Doctors say over 80 per cent of such cases occur in the developing countries with sub-saharan Africa leading the park with 24 per cent, followed by Caribbean/South America with 16 percent, Asia and Europe tied at 14 per cent each, in that order.

Countries with modern and the latest screening technologies have recorded fewer cases. Data from Nairobi alone, from the cancer registry at the Kenya Medical Research Institute (KEMRI), indicates that cervical cancer accounts for between 20 to 25 per cent of cancers reported in women in the period 2019 to 2021.

The figures are much higher nationally. The estimates by International Agency for Research on Cancer ((IARC) indicate that 2, 635 Kenyan aged between 15 and 65 develop cervical cancer, 65 percent of whom die of the disease.

This is because 55 percent of these women seek treatment when they have already reached stage three of the disease, when the surgical interventions or radiotherapy is unlikely to make any major impact on clinical outcomes.

The KEMRI data further indicates that cervical cancer incidence is increasing in Kenya. A small percentage of women with invasive cervical cancer have undergone pap tests. Professor Mugo says HPV is the most frequently sexually transmitted infection with 60 percent higher than HIV and Hepatitis B.

The risks for acquisition of the infection include early sexual debut, having multiple sexual partners, high risk male partners and the immune status of the individual, with the HIV infected being at a greater risk.

Smoking and long term contraceptive use have been established as minor risk factors. Consistent condom use has been shown to decrease transmission of cervical cancer by 70 percent. Male circumcision also reduces the risk of transmission.

 Non-sexual transmission does occur from mother-to-child called vertical transmission during childbirth and is thought to be the principle route of acquisition for recurrent respiratory papillomatosis that occurs most commonly in childhood, she notes.

Undergarments and surgical gloves have been hypothesised as some of the transmission routes for HPV, but not well nor substantively documented.

Research shows most individuals will acquire HPV soon after becoming sexually active. The lifetime risk of infection is about 70 percent, the peak attack rate for girls being between 14 to 24 years.

 The HPV infects the epithelial cell and integrates into the host genome, immortalising it to a cancer cell. The process takes long, between 10 to 15 years, except in immune compromised individuals who may have a faster progression rate of the disease.

The epithelial cells go through the pre-cancer stages during which changes can be detected by screening. Doctors recommend the use of pap smear test. If detected early and treatment commences immediately, it can prevent progression to invasive cervical cancer.

 This, according to doctors, is a secondary prevention measure. The virus is adopted very well for survival in human host cell. The slow development of the disease enhances immune surveillance escape.

The prophylactic vaccines have made it possible to prevent acquisition of the viruses most frequently associated with cervical and other ano-genital cancers. The vaccines are available in Kenya and are administered to young girls and boys starting from nine years to 26 years with three doses for Cervarix given six months apart; and two doses for Gardasil also given six months apart. These vaccines are said to be safe even in HIV positive individuals.

Meanwhile, Kenya has over 10 million women aged from 15 and above who are at high risk of HPV infections, which develop into cervical cancer. WHO says fatality among women in the country stands at 67 per cent. Yet this has resulted in many deaths.

Doctor Stephen Kavita, a medical officer in charge of Primecare Health hospital, says treatment for cervical cancer ranges from Sh180, 000 to Sh800,000. This is minus surgery, which costs from Sh1.5 million.

The  National Cancer Control Programme and National Cancer Institute say in 2021 report, that more than 80 percent of cervical cancer victims will survive with the condition after diagnosis if they get regular treatment, while 92 percent will survive throughout their life with the disease if it is detected in the first stage and treated.

Some of the contributing factors to Keny’s spiking cancer cases include exposure to sex at young ages, poverty, and economic hardships, adds Dr Kavita.

“In rural Kenya, early onset of sexual activity, low social class, poor personal hygiene, family history, the prevalence of HIV/Aids, ignorance about treatment, lack of medical facilities have aggravated the cervical cancer situation in the country,” says Dr Patrick Amoth, Director General in the Ministry of Health.

Dr Amoth reveals that the Government is setting up cancer screening centres in all regions and sub-counties with two screening machines per centre. This should enable young’ girls who must take advantage of the availability of the services 

Speaking at a workshop organised by Kenya Editors Guild (KEG), a cancer survivor, Mildred Ngesa, observes that the greatest tragedy and stigma is “silence about the disease, silence about one’s condition”.

Ngesa advises men to be faithful to their female spouses to limit the spread of cervical cancer.