Nzelu: Cervical cancer, icon of hope, hopefulness
JANUARY is Cervical Cancer Awareness Month. Cervical cancer epitomizes the cost-effectiveness of investing in preventive health care. Cervical cancer is the easiest of all cancers to prevent. Cervical screening is the best cancer screening test in the history of medicine and the most cost effective of all medical screening tests. The screening is painless and takes only about five minutes to perform. The tissue changes that lead to cervical cancer usually develop very slowly (over a period of about five to 30 years). Screening can find these changes before cancer develops. Pre-cancer changes are easy to treat by outpatient procedure lasting 15 minutes.
Furthermore, there is now a vaccine (Gardasil) for human papillomavirus (HPV). Human papillomavirus is the root cause of more than 5% of cancers, including nearly all cervical cancers and a substantial percentage of cancers at other sites such as vagina, vulva (the outer or external part of the female genital organs), penis, scrotum, perineum, anus, head/neck, mouth, throat, nose, tonsil, skin, nail-bed, and conjunctiva (eye). Gardasil prevents most cases of cervical cancer, warts, Recurrent Respiratory Papillomatosis (RRP) and a proportion of other HPV cancers. It can be given to males and females from the age of nine years (see the blog page of www.cecpng.org for details).
For these reasons, cervical cancer is now a disappearing disease in the western world. Unfortunately, cervical cancer has the ignoble status of being the cancer with the greatest disparity in its incidence between developed and developing countries. Debbie Saslow, Director of Breast and Gynecologic Cancer, American Cancer Society stated in 2013 that, “Sadly, this disease (Cervical Cancer) threatens to undermine the important gains worldwide that have been made in sexual and reproductive health, maternal and child health, HIV/AIDS and other infectious diseases. For women in many countries in Africa, Asia, and Latin America, cervical cancer is often detected late, when there is little hope for successful treatment. And it can be devastating to the whole family, both emotionally and financially.”
Cervical cancer, although highly preventable and curable with early detection, remains the leading cause of cancer deaths among women in the developing world. There are roughly equal cases of Maternal Mortality and Cervical Cancer annually – about 0.5 million cases/year worldwide). 83% of these deaths occurs in developing countries because, compared with women in industrialized countries, they have far less access to screening and virtually no access to treatment. Cervical Cancer kills more 24-35-year-old women in developing countries than any other cancer in any other parts of the world.
In Nigeria, most women are NOT aware of the need for cervical cancer screening; most have never had cervical cancer screening in their lifetime. As a result, cervical cancer kills about one woman every hour in Nigeria. The rural Nigerian woman is worse off, because of the absence of adequate medical facilities for screening, diagnosis and follow-up. Cervical cancer is the commonest cause of cancer-related death in women in parts of Nigeria. A strong risk factor for cervical cancer is early age at first sexual intercourse and first child birth. The practice of child marriage in parts of the country therefore contributes to a higher incidence of cervical cancer.
A case that underscores the importance of cervical cancer prevention is that of Mrs. M.S., a well- known Nigerian philanthropist, who died of cervical cancer on the September 18, 2014. N36 million had just been raised by her well-wishers, in a last-minute attempt to save her life. At the time she died she owed N25 million in hospital bills in Germany. Meanwhile, cervical cancer is virtually 100% preventable.
Here is a ray of light at the end of the tunnel. In 2007, the mass medical mission, a non-governmental initiative, pioneered community-based mass cervical cancer screening campaign in Nigeria, known as the National Cervical Cancer Prevention Programme (NCCPP). This initiative was later renamed the National Cancer Prevention Programme (NCPP) following the incorporation of other cancers. In spite of its limited resources, the NCPP has been at work since 2007; over 100,000 Nigerians have been directly screened and treated so far, and through the awareness created, the NCPP is helping to protect millions of Nigerians from cancer. NCPP is the current operational partner of the Committee Encouraging Corporate Philanthropy (CECP-Nigeria)
This sacrificial effort has contributed to a 15% reduction of cervical cancer deaths in Nigeria from 26 women dying daily to 22 daily between 2008 and 2012 (World Health Organization data). This improvement is significant given the fact that the World Health Organisation had projected a 25% increase in cervical cancer death rate within 10 years, in the absence of widespread intervention. However, we can do better in Nigeria.
The fact that 22 women still die of cervical cancer every day in Nigeria, is not acceptable. Each of these women is somebody’s precious wife, mother, sister and aunt. However, the recently reported improvement in cervical cancer survivorship in Nigeria is a proof that we can win the BIG WAR against Cancer if we could scale up the present effort. According to Dr. Christopher Wild, Director of International Agency for Research on Cancer (IARC), “These findings bring into sharp focus the need to implement the tools already available for cervical cancer, notably HPV vaccination combined with well-organized national programmes for screening and treatment.”
The current focus of CECP-Nigeria is to acquire and deploy Mobile Cancer Centres (MCC), which will energize the impact of NCPP particularly on the poor in our country through three separate, yet related interventions, viz: Intensive Awareness created by reaching every local government area at least once a year; screening for cancer and cancer-related killer diseases (Diabetes, Renal Disease, Malaria, Schistosomiasis, Helicobacter pylori, Hepatitis, HIV/AIDS, HPV and Hypertension); and prompt treatment of early cases, combined with an efficient referral of advanced cases. Each MCC costs about ninety-five million naira.
To actualize this vision, the CECP is currently involved in a fund-raising campaign, known as the #GivingTide. The #GivingTide is managed by a team made up of some of Nigeria’s most trusted and dedicated corporate leaders, led by Prof. Pat Utomi (See www.givintide.org, for details).
Meanwhile, in line with the objective of the Cervical Cancer Awareness Month, there shall be FREE BREAST and CERVICAL CANCER SCREENING as follows:
• Thursday, January 29, 2015 at Abibatu Mogaji Model Market, Iponri, Surulere, Lagos
• Tuesday, February 10, 2015 – screening for female inmates of Kirikiri Prison