cervical Cancer Vaccine
In 2004, Joycelyn, 37, had no reason to worry about her health. She was physically healthy and was not experiencing any health problems.
The thought that death could be knocking on her door was the last thing on her mind. Instead, she was focused on her family life as a mother, wife, sister and daughter until she noticed unusual bleeding from her vagina.
She says she became more concerned when a TV programme drew her attention to cervical cancer, pushing her to take the step to go for medical advice.
Joycelyn visited the cervical cancer prevention programme at the now Ridge Regional Hospital, where she was referred to a nurse for visual inspection with acetic acid (VIA) screening.
The VIA testing could determine whether the bleeding was an indication of cancerous lesions forming on her cervix.
On the day of her screening, Helen says she felt “… scared because I did not know what the screening entailed, and I am the type who cannot endure pain.”
She, however, went through the test and a specimen was taken to Korle-Bu Teaching Hospital for further tests.
Joycelyn’s specimen came out positive and her laboratory records reported “diffuse large-cell malignant lymphoma of the cervix.”
In other words, Joycelyn had invasive cervical cancer.
“I was really disturbed and confused because I least expected it,” she recounts.
CERVICAL CANCER
Cervical cancer develops slowly after initial infection with human papillomavirus (HPV) which is made worse by the presence of weakened immune system, caused by other diseases like diabetes, HIV, AIDs, among others.
There are two primary types of cervical cancer, squamous cell carcinoma, which begins in the thin flat (squamous) cells lining the outer part of cervix according to the World Health Organisation (WHO) data.
The most common type of cervical cancer, adenocarcinoma, begins in the column-shaped glandular cells lining cervical canals.
The international health body says although women often do not experience symptoms until the disease has advanced as the tumour becomes larger, in most cases, the first symptom to develop is abnormal vaginal bleeding such as bleeding between normal periods (intermenstrual bleeding), bleeding after having sex (post-coital bleeding), any vaginal bleeding in women past menopause, vaginal discharge that smells unpleasant, pelvic pain discomfort or pain after sexual intercourse and bleeding after intercourse.
“Simple screening methods can detect precancerous lesions. If such lesions are detected, there are a range of treatment approaches that can be used to prevent the disease from progressing,” the World Health Organisation information states.
Treatment for cervical cancer includes surgery – an operation to remove the cervix and uterus (hysterectomy) and sometime parts of the uterus.
Radiotherapy is also another treatment option which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells or stops them from multiplying.
Chemotherapy uses anti-cancer drugs which kill cancer cells, or stops them from multiplying is another treatment option. Chemotherapy may be given in addition to radiotherapy or surgery in certain situations.
The WHO states that women in their thirties and forties are at highest risk for the treatable precancerous lesions that can progress to cancer. Cervical cancer rates peak among women in the fifties and sixties.
STATISTICS
Cervical cancer is a preventable disease but each year close to a half million women are diagnosed with cervical cancer, and nearly a quarter million women die from the disease globally, figures from the Catalan Institute of Oncology (CIO) and the International Agency for Research on Cancer (IARC) state.
The vast majority of these women live in developing countries where effective prevention programmes—and awareness of the problem—are often in short supply.
In fact, in most developing countries, cervical cancer is the leading cause of cancer deaths among women, according to the CIO.
In Ghana, 3,052 women are diagnosed annually with cervical cancer, out of which 1,556, representing more than half, die from the disease. Women over 15 years of age constitute almost 8.6 million of the country’s population are at risk of contracting the disease.
Although there is no data on the prevalence of HPV virus among Ghanaian women, 4.3 percent of women in West Africa have HPV-16 and HPV- 18 infections.
According to the ICO fact sheet for Ghana, the mean age of those diagnosed with cervical cancer is 35.4 years old while the mean age of mortality is 54.3 years old.
Ghana has a poor record of cervical cancer screening. Records by the ICO indicates the percent of women screened every years by age are 18 to 29 (2.9 percent) 30-39 (4.0 percent) 40-49 (2.7 percent), 50-59 (0.2 percent) and 60-69 (0.9 percent).
TREATMENT
A staff member from the screening site accompanied Joycelyn to Korle-Bu Teaching Hospital and ensured that she received appropriate services.
The physicians at Korle-Bu work closely with the cervical cancer project at the hospital to provide advanced care to women diagnosed with cancer or other gynaecological conditions like Joycelyn’s.
Because the cancer was detected at a later stage, Joycelyn required radiotherapy treatment and invasive surgery as well. Radiotherapy is not normally available to people in Ghana, but Joycelyn fortunately had access to it through the cervical cancer prevention project, Cervicare.
After months of treatment, doctors at the Korle-Bu Teaching Hospital were able to cure Joycelyn of her cervical cancer as the treatment was successful.
While Joycelyn now says her treatment was successful, it brought several hardships during the process.
“Sometimes I was in so much pain that I really did not know what to do, and still today I feel pain where the radiotherapy treatment was done,” she recalls.
In addition to the physical discomfort, Joycelyn says she was distressed about the costs of treatment and transportation to the hospital.
She was, however, fortunate to be a participant in the cervical cancer prevention project, Cervicare, which reimbursed her for her expenses and provided the radiotherapy free of charge.
In addition to support from the project’s staff, Joycelyn received comfort from her family. “During the time I was sick, even though my family could not visit me, they always sent me words of encouragement,” she reveals.
Cervical Cancer Prevention
Even with the many hurdles she had to overcome, Joycelyn feels fortunate and therefore has become an advocate for early screening for cervical cancer.
“I began talking to some women about cervical cancer and its associated problems,” she explains.
Joycelyn does not want other women to face the disease unnecessarily, so she encourages them to take advantage of early screening and treatment which can prevent the disease. “I was afraid I would die, so I wanted to know what brings about the disease.”
As she discovered, awareness is one of the most important keys to prevention.
Joycelyn is not the only woman in the cervical cancer advocacy pursuit, Helen a mother who had undergone cervical cancer screening with negative results believe education can save more women from going through the unnecessary pain.
Helen, after hearing about cervical cancer and the method for screening – inspection with acetic acid (VIA) – decided to participate in the testing.
“My husband had been pressuring me to go for screening, but I was always postponing it until I finally decided to take the opportunity,” she says.
After the procedure, which Helen described as “painless, simple, smooth, and comforting,” she was informed that her test result was negative.
Helen says, “I feel women should be educated on some of these important issues because they are vital to their health. I will speak to and encourage the women and youth in our church so that they can also take advantage of the programme.”
Thinking about her experience, Helen explains that, “I was not worried about the decision I took to undergo screening at all because I think life is too short for one to take for granted, so I made up my mind to make use of the opportunity.”
National Vaccination Programme
A national vaccination campaign to protect young girls against cervical cancer was launched in 2013, under the initiative of former first lady, Lordina Mahama.
The campaign, the Human Papilloma Virus (HPV) vaccination programme, was funded by the GAVI-Alliance and the Danish government.
A year on, about 33,000 school girls were vaccinated in the pilot programme.
Key Points (Pull Out)
The Alliance for Cervical Cancer Prevention (ACCP) has indicated cervical cancer is treatable when caught in early stages, and women such as Joycelyn can recover.
The Alliance also outlines a few key issues that can help policymakers tackle cervical cancer through early detection and treatment.
- Early detection and treatment saves lives. It is critical for women in their thirties and forties to be screened for precancerous lesions, even if they are not experiencing symptoms.
- Given cervical cancer’s slow progression, screening to identify pre-cancer before it becomes cancer is critical to preventing illness and death.
- This underscores the need to screen women in their fifties who have never been screened—in addition to women in their thirties and forties— as they are at high risk for cancer.
- Women are often advocates for one another as well. As shown in Joycelyn’s story, cervical cancer survivors—as well as women who have simply undergone screening or treatment of precancerous lesions like Helen — can provide crucial encouragement to other women considering screening.
- Increasing awareness programmes can encourage early screening and strengthen the likelihood that lesions can be successfully treated.
By Jamila Akweley Okertchiri