January is Cervical Cancer awareness month. The global community is coming together to increase awareness of the burden of this preventable cancer. Cervical cancer is a disease of significant disparity. Of the approximately 570,000 new cases diagnosed yearly worldwide, 85% occurred in low-and middle-income countries, where women lack access to life-saving prevention, including vaccination and screening.
Women living with HIV – the majority of whom reside in sub-Saharan Africa – are up to six times more likely to get cervical cancer. This disparity is driven in part by the lack of access to treatment during the pre-cancer stages, when abnormalities in the cervix can be treated and cured.
But there is hope.
The Ministry of Health in Kenya is heeding the recent World Health Organization call for the global elimination of cervical cancer. Kenya has ramped up efforts to increase screening to help turn the tide of cervical cancer deaths among women, especially among low-income communities. Starting in January of 2021, the Comprehensive Care (HIV) Clinic at Lumumba Hospital in Kisumu County started offering a life-saving procedure to treat women with cervical pre-cancer. The clinic is supported by Family AIDS Care and Education Services (FACES), a collaboration between the Kenya Medical Research Institute (KEMRI) and the University of California, San Francisco (UCSF).
Cervical cancer can be prevented through vaccination against the human papillomavirus (HPV), which causes the disease. Additionally, regular screening of women can detect early signs of cervical cancer (known as pre-cancerous changes) that can easily be treated and cured, preventing progression to cancer. Screening saves lives, as these pre-cancerous changes are almost always completely treatable.
However, women, particularly poor women who lack access to a trained gynecologist, have often gone without this life-saving treatment because it was not available in their local clinic, and referrals to other hospitals are difficult and expensive. In Kenya, there is one doctor for every 16,000 people, a minority of whom are trained gynecologists, and even fewer working in rural areas.
One way to remedy this shortage of doctors is to train health care providers who already work in the communities where vulnerable women live. Instead of referring women to inaccessible, faraway hospitals for treatment, the FACES clinic at Lumumba Hospital is now offering Loop Electrosurgical Excision Procedure (LEEP), a 15-minute outpatient procedure where pre-cancerous cells can be removed by a trained clinical officer.
This procedure prevents progression of the changes to cervical cancer, saving a woman’s life. A recent study at FACES showed that LEEP provision by clinical officers safely expands access to this life-saving procedure. The FACES clinic primarily serves HIV-positive women, who are at highest risk of getting cervical cancer. However, all women, regardless of HIV status, can get cervical cancer, and need regular screening. By providing the LEEP procedure to women in their community, FACES is doing its part to address this preventable health disparity.
Spread the word amongst all the women in your life. Cervical cancer screening is available in most public facilities in Kenya at little to no cost, and it can save your life!
Dr. Chemtai Mungo, OBGYN