End of embarrassing moments in cervical cancer screening

Deaths associated with the disease are expected to go down drastically as local scientists roll out a new screening method which allows women to collect samples for testing all by themselves without the intervention of a doctor or a nurse. 

Jemimah Waswa, a computer sales lady in Nairobi, is worried stiff about cervical cancer. But the 32-year-old mother of two shudders at the thought of being screened for the killer disease. The screening procedures, she says, are too embarrassing and intrusive.

“The first time I went for a pap smear screening at the Kenyatta National Hospital, I was asked to remove my clothes, lie on a table-like bed and put my legs apart,” she says shyly.

“A male doctor came and inserted a long, cold metallic object into my birth canal that he said was to open it up so he could see whether my cervix had signs of the disease or not. He scraped my cervix with another object for samples that were to be taken to the laboratory for testing.”

Jemimah says the whole procedure took only a few minutes, but it left her with a bitter feeling. “That was just too much for me. Being made to expose my private parts in such a manner to a male stranger was a violation.”

When the pap smear results came back, she was told they were negative. She was, however, advised that she needed to be screened every year or so to check for any new signs of cervical cancer.

She has since been wondering whether or not to go back for another such screening and prays that nothing has gone awry since her last check-up.

Like Jemimah, many women often avoid repeat or first-time screening for cervical cancer because of the “embarrassing” procedures involved. Indeed, several local research studies have linked the low cervical cancer screening — less than 10 per cent of Kenyan women go for the tests — partly to the embarrassment women go through during the tests.

Dr. Fredrick Kairithia, a Nairobi-based consultant obstetrician-gynaecologist, says many women are uncomfortable with pap smears due to the prevailing taboos surrounding sexuality and reproductive health in the society.

“Some women feel too embarrassed to expose their private parts to doctors. If this is not addressed through robust public education campaigns, it may hamper further uptake of cervical cancer screening and lead to more deaths,” he says.

But that will soon be a thing of the past. A new initiative that is being rolled out in the country hopes to encourage more women to go for cervical cancer screening and cut deaths from the disease by making the procedure less embarrassing.

The initiative allows women to collect samples for testing all by themselves without the intervention of a doctor or nurse.

It also uses a new technology for screening, making the dreaded pap smears and visual inspections unnecessary for most women.

“Kenyan women are able to do the self-collection of samples by gently swabbing the inner parts of the birth canal using a soft collection kit called an Evalyn Brush, which we supply and is customized and validated for this purpose,” says Dr. Ahmed Kalebi, CEO of Lancet Laboratories, who is advocating for enhanced cervical cancer screening in Kenya.

He says the self-collection kit can then be returned securely and even anonymously to the laboratory for testing. “We expect Kenyan women to be more comfortable with this. Of course, ladies who don’t mind can still have the swab done by a doctor or nurse,” he says.

Dr. Kalebi says that the swab from the birth canal would be tested using a new technology to see if it has the virus that causes cervical cancer — the Human Papilloma Virus.

The technology, dubbed Cobas and manufactured by Swiss pharmaceutical firm Roche, identifies 14 high-risk strains of the virus that are linked directly to cervical cancer, including the type 16 and type 18, which cause over 70 per cent of the disease.

“Women who test negative for the virus have virtually no risk of developing cervical cancer until three to five years later, when they need to be tested afresh. They will not need pap smears or visual inspections during that period. Usually, the majority of women fall in this category,” he says.

Those who test positive, he says, would need regular monitoring by gynaecologists to see if their cervices have signs of developing cervical cancer. It can then be treated quickly.

According to Dr. Rabia Mukadam, a molecular scientist at Lancet, the new screening technology allows pap smears and visual inspections to be used only on women who have higher risks of getting cervical cancer due to presence of HPV.

“Currently, all women of reproductive age and are sexually active are required to undergo pap smears or visual inspections. But with the new technology, only a small fraction of them (seven to 15 per cent) with high risk of the disease will need the procedures. This should be a big relief for many Kenyan women,” she says.

Dr. Mukadam points out that HPV is spread through sexual intercourse and in many cases, the body clears it away naturally through the immune system and causes no damage.

But in some cases, the virus persists and causes precancerous changes that eventually lead to cervical cancer if not detected and treated early.

She clarifies that having HPV does not mean that a woman has cervical cancer, but has higher risks of developing it.