Titilayo Akande, a 45-year-old mother of three, was diagnosed with cervical cancer in 2015. Despite having come with no initial symptoms, the tumour had begun to grow. Fortunately, however, it had not spread to other organs when it was diagnosed and the treatment commenced. Though scared of the treatment, Akande determined to go through, and successfully survived it.
Cervical cancer develops in a woman’s cervix – the entrance to the uterus from the vagina. Experts affirm that almost all cervical cancer cases (99 per cent) are linked to infection with high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact. Although most infections with HPV resolve spontaneously and cause no symptoms, persistent infection can cause cervical cancer in women.
According to the World Health Organisation, cervical cancer is the fourth most common cancer among women globally, with an estimated 604,000 new cases and 342,000 deaths in 2020. About 90 per cent of the new cases and deaths worldwide in 2020 occurred in low- and middle-income countries.
It has also been established that women living with HIV are six times more likely to develop cervical cancer, compared to women without HIV.
For Akande, who is now a survivor, she was not living with HIV, and surprisingly she had seemed well all along, until she started bleeding within her menstrual cycle and also experiencing fatigue and other ailments. This led her in search of a gynaecologist. Thankfully, it was diagnosed that her cancer was still in stage two, and therefore treatable.
She shared her story thus: “Three months before my retirement, I started bleeding between menstrual cycles. I attributed it to being stressed, since I was getting ready to wrap up a 20-year career. At the time, I had not seen a gynaecologist in three years. Why? Well, my gynaecologist had retired, and I didn’t look for a new one. I didn’t feel the dire need to find one since I felt fine. I had no symptoms whatsoever. I had been married for 10 years and I was in a monogamous relationship. However, the progressive bleeding, fatigue, and bloating pushed me to go see a doctor.
“I went to a new gynaecologist, who took a biopsy, which came back inconclusive. She told me she needed to refer me to a gynaecologic oncologist. When I went to the oncologist, he took another biopsy and those results revealed I had cervical cancer, stage IIB.
“My doctor decided to treat me with a combination of radiation, chemotherapy, and brachytherapy (internal radiation). The journey was tough. At times I wanted to give up, but my husband and family kept me going. I consider myself one of the lucky ones because after treatments, my tumour disappeared and there weren’t any visible cancerous cells. After nine months, I was cancer-free.”
Burden of cervical cancer in Nigeria
Nigerian researchers have identified cervical cancer as the second most common cancer (after breast cancer) among Nigeria’s female population, with 12,000 cases diagnosed annually and 8000 annual deaths. This translates to 33 new cases and 22 deaths from the disease daily.
In an interview with Professor Oliver C. Ezechi, director of research and consultant obstetrician and gynaecologist, Nigerian Institute of Medical Research (NIMR), he asserted that over 36 million Nigerian women above age 15 are at risk of coming down with cervical cancer. He further noted that increase in vaccination of young girls, screening of women and awareness creation about the disease will go a long way in stemming the spread.
Early detection vital in combating cervical cancer
In stemming morbidity and mortality from cervical cancer, medical experts including Prof. Ezechi; Prof. Juliet Iwelunmor of the College for Public Health and Social Justice, Saint Louis University Missouri USA; Professor Joseph D. Tucker, of the University of North Carolina Chapel Hill, USA; and Dr Ucheoma Nwaozuru, Wake Forest University School Medicine, recently flagged off a cervical cancer prevention project in Nigeria, tagged ACCESS–HPV.
Ezechi averred that cervical cancer is one of the most preventable and successfully treatable forms of cancer, if detected early and managed effectively.
“Like many cancers, the earlier cervical cancer is detected, the higher the chances of survival,” he said.
Addressing challenge of access to HPV vaccination
The consultant obstetrician and gynaecologist, however, attributed the high prevalence of the disease in Nigeria and the resultant number of deaths among women to poor access to effective and adequate treatment services.
“The inequity in access to service has been attributed to compelling healthcare priorities, insufficient financial resources, weak health systems, and limited numbers of trained service providers”, he observed.
To bridge the gap in vaccination for HPV, which is only available in private facilities, Ezechi said his team’s research project, “Actions for Collaborative Community Engaged Strategies for HPV (ACCESS-HPV)” aims to support the Nigerian national cancer prevention and control programme, towards achieving its drive to join other nations of the world to eliminate cervical cancer by 2030.
In explaining the research methodology, Prof. Iwelunmor explained that the team will explore the bond between mothers and daughters to drive home the message of the importance of HPV vaccination, to improve the uptake of the vaccine.
She added: “We will develop new vaccination campaigns for young girls and HPV self-collection campaigns for mothers, using crowdsourcing open calls and participatory learning communities.
“We will also determine the effectiveness of a final campaign on the uptake of HPV vaccination among girls (ages nine to 14) and HPV self-collection among mothers (ages 30 to 49) using a stepped wedge randomised control trials.”
Need for multi-sectoral approach
Pharmanews interaction with other stakeholders shows that there is need for multi-sectoral approach to change women and girls’ dispositions towards the uptake of HPV vaccine and screening. While some cited religion as a barrier, others noted the need to enlighten teachers and school management on the importance of HPV vaccination for girls and cervical cancer screening for women.
Mrs Mutiat Adepoju, a pharmacist with the Lagos State Primary Healthcare Board, and an executive of a Muslim organisation, NASFAT, expressed Islam’s view on HPV vaccination, saying it is acceptable, provided it is for saving lives.
“Islam holds that anything that prolongs your life and prevents death is good. So, cervical cancer screening and HPV vaccine are good steps in preventing mortality from cervical cancer in our women and girls. Islam is not against girls receiving the HPV vaccine,” she affirmed.
For women, she identified regular screening as the best option, because there may not be any sign at the onset.
For the Vice-Principal, Reagan Memorial Baptist Girls Secondary School, Yaba, Mrs Ruth Okey, there is need for increased advocacy on HPV vaccination for girls, as most women and girls are oblivious of it.
She said, “I’m aware of other cancers, but only got to know about this when Rotary Club members came to our school to seek our indulgence on the HPV vaccination for girls against cervical cancer.
“We have been trying to enlighten parents on the importance of the vaccine and why they should allow their girls take it .We have already sent consent forms to parents to fill for their daughters. When we get enough consent forms, then we will invite Rotary Club members for the exercise.”
A student of Reagan Memorial Baptist Girls School, Sharon Iwuamadi, also revealed that she had been ignorant about the disease and the required vaccination, until a group of scientists invited some of the girls for enlightenment. She, however, added that even though she is better informed now, she cannot take the vaccine without her parents’ consent.