Kenya: Affordable New Weapon Against Cervical Cancer

Susan Anyangu

 Nairobi — Faced with an increase in
the number of cervical cancer cases,
Kenya has adopted a simple, cheap yet
effective visual inspection method
of detection.
Ideal for low resource settings, the test
is offering reprieve to thousands
of women who die annually from the disease.

"It is now possible to test for lesions
that if left alone will lead to cervical cancer.
Using table vinegar, which costs less
than a dollar, we can test six to ten women,
" says Margaret Odhiambo
a nursing officer at Kisumu Provincial Hospital.

Government hospitals in Kenya are now
encouraging women of reproductive age
to undergo the free test.

"We are now testing between
20 to 30 women in a day which
is a marked increase from past records
when we relied on Pap smear.
In the past women have been
coming to us when the disease
has advanced and little
can be done," says Odhiambo.

According to statistics from
World Health Organisation
and United Nations Population
Fund (UNFPA), cervical cancer
is caused by the human papillomavirus
and affects about 500,000 women
worldwide each year
and kills 270,000 annually.

According to Dr Paul Mitei, the head
of department in the gynaecological ward
at Kisumu Provincial Hospital,
cervical cancer is one of
the leading killers in Kenya - and
indeed the rest of the world.

Yet it is possible for a trained
medical worker to visually detect
the presence of the lesions
within ten minutes, he says.

The method involves dilating
the vaginal walls, applying a solution
of acetic acid found in vinegar
and performing a visual inspection
using a bright halogen light (torch).
Once the solution is applied,
suspect lesions turn white,
while healthy tissue shows
no colour change.

"Once detected, the lesions are
treated instantly through freezing
and within 10 minutes the patient
can go home and will not need
to be seen for another five years,"
says Dr Mitei.

Dr Mitei explains the lesions are
treated using cryo-therapy - a process
through which liquid nitrogen is used
to freeze the affected tissue
and destroy the lesions.
In other cases, a loop electro-surgical
exicision procedure is used
to excise the lesions; a painless electric
current quickly cuts away
the tissue surrounded by a small lop of wire.

Not all hospitals have
cryo-therapy equipment, according
to Jacton Omotto the district
gynaecologist at Siaya District Hospital,
but he says most provincial hospitals
are equipped.
Discussions are underway with
donors to purchase more
equipment for distribution countrywide.

According to Dr Omotto, studies across
the world have proven the efficiency
and effectiveness of
the visual detection of lesions.

"Studies have proven the visual
inspection method is as efficient
as Pap testing in identifying
cervical cancer precursors.
However, Pap requires much more
sophisticated equipment,
training and logistics.
The visual inspection method
can be done by any trained medic,"
Omotto says.

"In the past, when we suspected
cervical cancer we would refer
the patient to a higher level facility
for testing and treatment," he adds.
"However, due to poverty many would
not travel to Nairobi where Kenyatta
National Hospital is located.
Instead they would stay home
and would be brought back
in a critical condition."

When Violet Opala learnt of this
simple mode of detecting cancer,
tears streamed down her cheeks.
The information rekindled memories
of her mother, who died of cervical cancer
early this year.

Opala contends that had her mother
got a chance to be tested using
the visual inspection method,
she might be alive today.

"Following the fatal diagnosis,
my mother was in and out of hospital
for four years then she succumbed.
By the time she was diagnosed,
the doctors told us it was too late
and the cancer had spread,"
Opala explains.

She adds, "I am told cancer is hereditary.
My sisters and I have been worried sick
at the possibility of testing positive.
However, we have never undergone
the test due to the prohibitive costs
of getting checked.
Fear has also been a contributing factor,
the idea of waiting for the results
is simply agonising."

Now that the visual inspection
is being offered, the thirty-eight year old
says she may brave it all and get tested.

"It is encouraging to know that
if the lesions are found in
their early stages they
can be treated.
Maybe my sisters and I can get
the much needed reprieve
that my mother never got," she says.

Dr Omotto concurs, adding
that increasingly younger women
in early twenties are being
diagnosed with cancer of the cervix.

"It is a reality on the ground
that cases of cervical cancer are
on the increase and this is
mainly due to increased risk factors.
What we have noticed is that
HIV positive women tend
to develop cervical cancer, "Omotto says.

What is unfortunate according
to Kisumu hospitals Mitei, is that
many patients come to hospital when
it is too late and their condition
is beyond the stage where
even surgery can be used to intervene.

"Cervical cancer has been mystified
and unfortunately many remain
ignorant to the fact that early detection
can be life saving.
Once the pre-cancerous lesions
are detected they can be treated," Mitei says.

The two doctors contend there is
a huge discrepancy between
cervical cancer deaths in rich
and poor nations.

Eighty to 85 per cent of deaths related
to cervical cancer occur in
the developing world,
a majority of these in Africa.
 
"In richer nations, screening using
Pap smear is in place to spot
the disease and treat it early,
saving the lives of thousands
of women.
However, a successful Pap testing
requires highly sophisticated
laboratory equipment
and trained technicians.
This has thus not worked well
in poorer regions including Kenya,"
says Omotto.

In that regard, he contends,
this inexpensive visual inspection
method will provide
hope for thousands of women.

There is a vaccine available that
prevents strains of the human
papillomavirus which causes
cervical cancer.
However, the vaccine
is prohibitively expensive.
Medics thus contend the best option
is to detect the pre-cancerous lesions early.

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