Treating Cervical Cancer, Is there a hope for African women?

By Linda Asante-Agyei, GNA

Accra, Aug 4, GNA - Women, as a result of their biological features, always bear the brunt of many diseases.

They have been created to bear children and after going through life threatening child delivery processes, have to suffer the brunt of other life threatening diseases and some of these are cervical cancer and breast cancer.

For every woman, before the age 20, her cervix is fully developed and frequent sex exposes them to Human Papilloma Virus (HPV) on the cervix. HPV is a germ that causes rashes on the cervix, which develops into cancer.

Women who experience early onset of sex before they attain 20 years and women with multiple partners are seriously at risk of having cervical cancer.

Women who bleach also stand a chance of contracting cervical cancer due to the use of dangerous chemical substances called steroids while women who smoke are likely to have breast cancer.

In an interview with the Ghana News Agency in Accra Mrs Gertrude Anteh, the Principal Midwifery Superintendent at Ridge Hospital, said cervical cancer like all cancers develops slowly, over a period of years, from cells that have changed. In the early stage, these changes are small that they are like a "rash" called dysphasia.

Though the early small rash could appear in a woman when she is in her twenties, it takes many years to develop into cervical cancer in women between the ages of 40 to 60 years.

The rash, caused by a HPV germ, often causes no symptoms making it very difficult for women to know they have the cancer.

The early stages of cervical cancer may be completely asymptomatic. Vaginal bleeding, contact bleeding or a vaginal mass may indicate the presence of malignancy.

In addition, moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer. In an advanced stage, metastases may be present in the abdomen, lungs or elsewhere.

Symptoms of advanced cervical cancer may include loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, single swollen leg, heavy bleeding from the vagina, leaking of urine or faeces from the vagina and bone fractures.

Cervical Cancer can be treated with cryotherapy when detected early. Cryotherapy, which uses cold gas, freezes the rash and stops it from growing and developing into a cancer.

Mrs Anteh said the procedure takes only 15 minutes and might cause some discomfort, abdominal cramps, adding, "After the treatment, your cervix is like any other wound, therefore it must be protected so that it can heal and not become infected."

The small rash in some women heal on its own while in other women it does not but develops into a large "sore" on the cervix, which is termed cervical cancer.

HPV testing could reduce the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cervical cancer when detected by subsequent screening among women within 32-38 years of age.

Globally, cervical cancer burden according to the World Health Organization (WHO) indicates that more than 270,000 women die of cervical cancer each year and nearly 90 per cent of these women live in the developing world.

The WHO also estimates that 12.5 per cent of all women in Western Africa are infected with human papillomavirus (HPV), the virus that causes cervical cancer. HPV infection is necessary for cervical cancer to develop, but HPV infection alone does not guarantee that cervical cancer will develop. Other health risk factors often contribute to the development of cervical cancer, these include high parity, use of tobacco products, long-term use of oral contraceptives, and HIV-HPV co-infection.

In Ghana, 6.57 million women over the age of 15 are currently at risk of developing cervical cancer. Each year in Ghana at least 3,000 women are diagnosed with cervical cancer and at least 2,000 women die from cervical cancer.

Cervical cancer is the most frequently diagnosed form of cancer in women in Ghana, including women between the ages of 15 to 44 years.

By 2025, the WHO predicts that there will be over 5,000 new cases of cervical cancer in Ghana and at least 3,300 cervical cancer deaths annually.

Cervical cancer is an entirely preventable type of cancer. At present, only 3.2 per cent of urban women age 18 to 69 and 2.2 per cent of rural women age 18 to 69 get screened for cervical cancer at least once every three years in Ghana.

Due to low rates of cervical cancer screening, there has been no significant reduction in cervical cancer incidence in developing countries in the past three decades.

Despite the availability of new vaccines for HPV, millions of women in the developing world including those who are vaccinated would benefit from cervical cancer screening. But the service usually is not available because of the technical complexity of Pap smears, which have proven difficult to sustain in low-resource settings.

The good news is that more affordable and appropriate tools to detect cervical abnormalities before they turn cancerous have been developed.

The WHO has confirmed that HPV testing could fill that gap, stating in its recommendations that "there is sufficient evidence that testing for human papillomavirus infection as the primary screening modality can reduce cervical cancer incidence and mortality rates."

A new test, the "careHPV DNA Test (QIAGEN)" to detect infection with the types of HPV that causes cervical cancer promises to bring better protection to women, no matter where they live.

CareHPV is a molecular test that detects 14 oncogenic HPV types. The test was evaluated in Shanxi, China, where 2,500 rural women were screened using vaginal and cervical samples.

Speaking to the Ghana News Agency, Dr Jose Jeronimo, Project Director for Screening Technologies to Advance Rapid Testing for Cervical Cancer Prevention-Utility and Programme Planning (START-UP) project at PATH, said screening tool had been developed for use in low-resource settings.

This screening tool he explained is an innovative answer to the challenge of early detection of the precursors of cervical cancer.

The test has been developed in partnership with PATH and PATH's goal is to make rapid, accurate pre-cancer screening feasible and accessible at lower levels of the public health care system, and to increase the number and types of staff able to provide effective and efficient screening and treatment services.

Uganda, India and Nicaragua were selected for field evaluation of careHPV. In addition to representing three major world regions (Africa, Asia and Latin America) these countries suffer high burden of cervical cancer, because they have scientific teams capable of conducting this type of project, and because they have the political support for cervical cancer prevention.

"The demonstration study being conducted as part of PATH's START-UP project will assess careHPV under actual field conditions and without sophisticated laboratory support. Lessons learned will inform other countries about the feasibility, effectiveness, and acceptability of this new test," he added.

Dr Jeronimo said results showed that the sensitivity of the test is much better than visual inspection methods and approaches that of QIAGEN's gold standard Hybrid Capture II test, but required less equipment.

Preliminary results from START-UP research show that test sensitivity is higher than Pap or visual inspection whether the sample is taken by the provider or the patient, and that self-sampling is popular among study participants.

Soon to be commercially available, careHPV yields results in approximately two and a half hours. A benefit of this rapid feedback is that initial HPV testing could be paired with visual inspection for treatment-triage at the district or country level, followed either by cryotherapy treatment in the same clinic or other treatment at a referral facility as indicated.

This "screen-and-treat" approach could dramatically reduce loss-to-follow-up observed when women are required to make repeat visits for screening, diagnosis and treatment.

In some situations, careHPV can be used with self-obtained vaginal samples (as an optional approach to the usual provider-obtained cervical specimen), decreasing the need for a speculum examination and enhancing test acceptability among patients.

According to Dr Jeronimo, "CareHPV is being assessed in Uganda, so we will have data on feasibility and acceptability in an African setting. And if international organizations are able to buy the test in bulk and at significant savings, this test could potentially bring HPV screening to many African women for the first time in their lives."

After the evaluation is completed, the next step would be to expand this new screening strategy to other parts of the African continent. PATH is partnering with multiple international organizations to explore options for educating medical doctors, midwives and other health care providers on the use of the new test, as well as providing adequate follow up and treatment of women with positive results.

PATH is also identifying and supporting regional and global champions for alternative screening and treatment technologies, working in close collaboration on that effort with the Cervical Cancer Action Coalition, the Alliance for Cervical Cancer Prevention, the World Health Organization, other UN agencies, and a host of professional societies.

It is our hope that after the screening, there could be a permanent treatment or a vaccine to salvage the conditions of these poor women who may have been infected with the cervical cancer virus.