Sundaymail Editor
THIS month, Zimbabwe joins the rest of the world in commemorating Cervical Cancer Awareness Month. The country has a high burden of cervical cancer and according to the Zimbabwe National Cancer Registry, cervical cancer constituted over 30 percent of the cancer burden in women in 2017.
Our Reporter Debra Matabvu (DM) spoke to Dr Nomsa Tsikai (NT), the chief oncologist for Cancer Care Network Trust Zimbabwe in Harare about the significance of the commemorations among other issues.
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DM: May you please give us a brief background of your organisation?
NT: The Cancer Care Network Trust Zimbabwe (CCNZ) was established in 2021 for the purpose of improving cancer services in Zimbabwe.
Establishment of CCNZ was in response to the rise in the cancer burden in Zimbabwe, which has resulted in significant morbidity and mortality.
A lot of patients are facing challenges with accessing care, from prevention, screening, early detection, treatment to palliative care and end of life care.
There is limited information on cancer and its prevention, early detection and treatments with patients often presenting with advanced disease.
CCNZ was, therefore, set up to bridge the information gap and provide the much-needed information on cancer, how to prevent and treat it and where to access cancer services from prevention, treatment, psychosocial support and palliative care services.
DM: How huge is the country’s cervical cancer burden?
NT: The burden of cervical cancer in Zimbabwe is huge. In 2017, the Zimbabwe National Cancer Registry (ZNCR) reported a total of 7 659 cancer cases in 2017 and of these 20 percent (1 532 cases) were cases of cervical cancer.
Looking at the Zimbabwean black female population, cervical cancer accounted for 37,1 percent of cases which is a very high figure.
DM: How has the Covid-19 pandemic affected the fight against cervical cancer?
NT: The Covid-19 pandemic has come with its set of unique challenges, which have added strain to an already burdened health system.
The challenges we have faced in the oncology community include the need to balance critical resources needed for patients with Covid-19 versus protecting patients and staff from unnecessary exposure and transmission of the virus within the hospital environment.
Covid-19 results in quarantines, hospital and clinic site closures, travel restrictions, which cause reduced access to health facilities for patients, leading to delayed diagnosis and treatment of cervical cancer.
There were interruptions with patient care resulting from patients or healthcare practitioners being infected by Covid-19 which in a lot of instances negatively impacted outcome of patients.
There was also a drug supply shortage due to interruptions to the supply chain.
We also experienced delays in getting radiotherapy machine spare parts when there was a need for equipment maintenance or in the event of machine breakdowns especially during 2020 and 2021.
It was an unfortunate situation for patients whose condition worsened whilst waiting for the situation to normalise.
DM: May you please highlight some of the success stories recorded by your organisation?
NT: CCNZ, although relatively new, is pleased with the progress it has made with regards to information dissemination especially on cancer prevention, diagnosis, treatment and palliative care.
We have also been instrumental in establishing strong patient advocacy with 2021 seeing the launch of the breast cancer and cervical cancer patient conferences, which brought patients together and encouraged dialogue on ways of addressing the challenges being faced by cancer patients in Zimbabwe.
DM: What were some of the challenges faced by your organisation and patients seeking treatment in Zimbabwe?
NT: Cervical cancer is a growing problem in Zimbabwe and is the leading cause of cancer deaths in women.
Unfortunately, a lot of women, including young to middle-aged women in the 20-60-year age group, present late with advanced Stage 3 or 4 disease, which in most cases is not curable.
The causes of this late presentation are many and include lack of awareness, fear, stigma and lack of finances to undergo screening.
Once diagnosed, patients are also facing challenges with accessing treatment because cancer treatment is centralised in Harare and Bulawayo. This means that many patients have to travel long distances to seek treatment, which a lot of patients cannot afford.
The cost of chemotherapy and radiotherapy is out of the reach of many people especially at private health institutions.
While treatment is available at public health institutions, patients face challenges of long waiting lists and frequent radiotherapy machine breakdowns, which leads to unacceptable delays in treatment.
DM: How can the Government and the private sector collaborate to inject impetus into the fight against cervical cancer in Zimbabwe?
NT: There is a lot that needs to be done to assist in the diagnosis and treatment of cervical cancer.
The most important is the work being done on governance and policy issues through the development of the National Cancer Prevention and Control Strategy and Plan and Zimbabwe Oncology Treatment Guidelines, which provide the much-needed direction into the implementation of a comprehensive national cancer control programme in Zimbabwe.
There is also a need to decentralise cancer prevention, diagnosis and treatment services in Zimbabwe in order to improve access to care for all Zimbabweans.
HIV infection has been found to increase the risk of developing cervical cancer due to immunosuppression.
It is, therefore, important for Zimbabweans to continue striving towards the control of HIV and the proper management of patients in order maintain as strong an immune system as possible.
It is also important to develop comprehensive cervical cancer screening services and make the HPV (human papillomavirus) vaccine available to young girls between the ages of 11 and 13 years.
The introduction of HPV vaccines has also been found to reduce the incidence of pre-cancer, which in turn will result in the reduction of invasive cervical cancer cases.
DM: What is the significance of commemorating the fight against cervical cancer in January?
NT: January is the month that is dedicated to raising cancer awareness.
Raising awareness includes information dissemination on the prevention, screening, early diagnosis and treatment of cervical cancer.
We educate the public on how common this cancer is and the burden it puts on society as a whole as we are, unfortunately, losing women, both young and old, to this disease.
We educate women on the causes of cervical cancer and what they need to do to detect the cancer early screening.
We have VIAC (visual inspection with Acetic acid) and Pap smear tests that are available for women from the age of 21 years onwards.
These tests help to detect cancer in its early stages before a woman develops symptoms.
DM: What are the causes of cervical cancer?
NT: The major cause of cervical cancer is the HPV virus, which is a sexually transmitted infection.
There are two main types of high-risk HPV virus called HPV 16 and 18 which cause 70 percent of cervical cancers.
Failure to clear the virus results in damage to the lining of the cervix, which can then predispose to the development of cervical cancer.
Factors that increase the risk of acquiring the high-risk HPV virus and hamper clearance of the virus from the cervix are associated with the development of cervical cancer.
These factors include immunosuppression from conditions such as HIV, poverty, starting to have sexual encounters at a young age, multiple sexual partners, a husband or sexual partner with multiple sexual partners, unprotected sex, use of vaginal drying herbs and having many children.
Most importantly it is important to note that all women who are sexually active or have been sexually active at some point in their lives are at risk of developing cervical cancer and are advised to undergo regular annual screening with Visual Inspection with Acetic acid and Cervicography (VIAC) or Pap smear from the age of 21 years.
DM: There are reports that some health centres are refusing to dispense anti-retroviral medication to some women unless they undergo a VIAC? How true is it?
NT: VIAC is good because that is a screening test for cervical cancer
and HIV is a risk factor for cervical cancer.
Over the years we have been saying women are seeking treatment for cervical cancer when it is an advanced stage but every month for the past five to 10 years, the woman was receiving ARVs at health centres.
So we put these clinics to task and ask them to test HIV positive women so that cervical cancer is detected early. We are losing a lot of women to cervical cancer and half of them are HIV patients.
Over the years we have been advocating for such tests.
However, not having a VIAC test should not mean one cannot access ARVs. The tests on the other hand are recommended after every six months for women living with HIV.
DM: What are the signs and symptoms of cervical cancer?
NT: The symptoms of cervical cancer include; abnormal vaginal bleeding, which could be inter-menstrual, post-menopausal, post-coital (after sexual contact) or contact bleeding.
One can also present with abnormal vaginal discharge and in some cases pain or discomfort during sexual intercourse, pelvic and/or back pain. In the more advanced cases, one can experience swelling of the legs and difficulty in passing urine and/or stools.
If one has any of these symptoms, it is important to seek medical attention from your nearest health facility.
It is important to remember that one does not have to wait to develop these symptoms because at times the disease may be too advanced and no longer curable when diagnosed. We therefore recommend screening to detect cervical cancer early.
Screening means testing women who have no symptoms of the disease.
DM: How is cervical cancer treated?
NT: The treatment of cervical cancer depends on the stage of disease.
When the disease is caught early at stage 1 or 2, meaning the disease is localised to the cervix or upper vaginal walls, surgery may be done to remove the uterus.
The stage 1 or 2 patients can also be offered chemotherapy and radiotherapy which serves to eradicate the disease.
When the disease is more advanced, at stages 3 and 4, there is evidence of spread to nearby structures or to distant organs such as the liver, lungs or bones.
In these cases, patients require treatments such as chemotherapy and/or radiotherapy.
These treatments are beneficial to control the disease.
These patients require palliative care, which also includes pain control with drugs such as morphine which are very beneficial and serve to free patients from pain.
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