Why cervical cancer should be declared a national disaster

Human papillomavirus vaccine - administration of antigenic material (vaccine) to stimulate an individual's immune system to develop adaptive immunity to a pathogen. [Getty Images] Cervical cancer is a malignant neoplasm of the cervix and one of the severe threats to women's health. While it is completely asymptomatic in the early stages, it presents a severe challenge to women in the advanced stages of the disease. Common symptoms include unexplained weight loss, pain after sexual intercourse, chronic pelvic pain, and bleeding between periods and after sexual intercourse. According to the International Agency for Research on Cancer, cervical cancer is the fourth most prevalent cancer globally among women, with 60,4127 new cases and 341,831 deaths recorded in 2020. About 90 per cent of the new cases and deaths worldwide in 2020 occurred in low-and middle-income countries. In Kenya, cervical cancer remains the leading cause of cancer-related deaths and the second most common cancer among women. Specifically, 5,236 new cases and 3,211 cervical cancer deaths were reported in 2020. However, these numbers do not represent the reality of cervical cancer in the country, as there are many undiagnosed cases. The primary cause of cervical cancer is chronic infection with one or more o "high-risk" types of human papillomavirus (HPV). In Kenya, about 9.1 per cent of women are suspected to harbour HPV-16/18 at any given time, with 63.1 per cent of invasive cervical cancers attributed to these two HPVs. The high mortality rate from cervical cancer in Kenya is a significant public health concern and must be addressed effectively. Women, especially those living in rural and low-resource urban settings, are at increased risk of cervical cancer because they lack access to essential services. While numerous awareness programmes are conducted, most of these are limited to urban centres, and therefore fail to reach the critical mass in need of this information. In a country where a significant percentage of women act as breadwinners and heads of households, diagnosis and deathfrom cervical cancer present a significant economic challenge. Public health experts will agree that the increasing mortality of cervical cancer cases in Kenya is unnecessary. Numerous cervical cancer deaths are diagnosed at autopsy, making this a silent killer. Many Kenyans reading this know a family or two experiencing this reality. The Kenyan government should declare cervical cancer a national disaster so that it receives the attention it requires. While we are exposed to the perennial effects of drought and floods that affect the country, a part of the population is dealing with the trauma of cervical cancer, a largely preventable disease. Through the National Cancer Institute (NCI-Kenya), the government has a policy framework to deal with cancer prevention and control. This organisation, established by the Cancer Prevention and Control Act No. 15 of 2012, advises the Cabinet on the treatment and care of persons with cancer. Currently, there are four vaccines against HPV-16/18, which contribute to over 70 per cent of cervical cancer cases. Clinical trials and post-marketing monitoring demonstrate that these vaccines are safe and effective in preventing HPV infections. These vaccines work best before pre-exposure to HPV; this is why the WHO recommends administering the vaccines to girls aged 9-14 years before becoming sexually active. In 2019, the Kenyan government approved HPV vaccines for girls aged 10 years. However, data from 2020 shows that vaccine uptake has been sub-optimal, with 33 per cent of the targeted population receiving the first dose with 16 per cent returning for the second dose. While the pandemic may have slowed down access to public health facilities, this low uptake may be due to various challenges. Vaccination, especially in the Covid-19 era, is a volatile topic and raises many questions from the public. Yet, in cervical cancer, HPV vaccines are effective preventive measures against future diseases. In England, researchers showed that vaccination has almost eliminated cervical cancer in women born since September 1, 1995 (vaccinated at age 12-13 years). The researchers also reported a reduced incidence of late-stage cervical intra-epithelial neoplasia (CIN) that could later develop into cancer. In Rwanda, national HPV vaccination programmes started in 2011 targeting 12-year-old girls attending primary school. A report published in 2012 showed that this programme achieved coverage of 93 per cent. Follow-up studies showed that HPV6/11/16/18 prevalence was lower in vaccinated than in unvaccinated students with an overall effectiveness of 78 per cent. Based on these studies and others not reported here, NCI-Kenya must work with county governments and the Ministry of Health to ensure optimal uptake of these vaccines. Kenya has a working and effective vaccination programme against diseases such as measles, tuberculosis, mumps, rotavirus, polio, tetanus, meningitis, typhoid, and chicken pox, among others. These vaccinations are set under the Kenya Expanded Immunization (KEPI) Schedule and are effective in curbing child mortality. One important recommendation to the government is to include HPV vaccination in the KEPI schedule but to be administered when children turn 10 years. Given the volatility around HPV vaccines, there must be public participation to educate and inform the public about the reality of cervical cancer and the effectiveness of these vaccines. Importantly, HPV vaccinations must not replace cervical cancer screening. Cervical cancer screening is done among asymptomatic women who may feel perfectly healthy. Screening helps detect HPV infection, pre-cancerous lesions, or cervical cancer at an early stage where treatment has an excellent potential for cure. Screening usually starts from 30 years, with regular monitoring every 5 to 10 years with a validated HPV test. However, given the high prevalence of HIV in Kenya among young people, cervical cancer screening should begin earlier to detect likely HPV infections. Kenya has everything it needs to eliminate HPV-associated cervical cancers and save women lives.

Why cervical cancer should be declared a national disaster

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