As part of the main drivers of the BAM Group of Companies, this being the umbrella company within which Informative Newspaper operates, alongside sister brands Finite Magazine, Finite Lifestyle Club, Bam Promotions and Twin Talk, Informative Newspaper takes particular interest in social issues and causes created to advance the development of young girls and women and their participation in the global space.
To advance and cement the organization’s support for women and young girls, the Sexual and Reproductive Health and Rights is today, through this issue introduced. Its purpose is to advance knowledge and create further awareness on developments surrounding the said community sector and to help audiences stay updated on such, further guiding means of both action and reaction to these developments.
This week we discuss Cervical cancer screening and prevention
Cervical cancer is the most common cancer in women in sub-Saharan Africa, partly due to the high levels of HIV amongst women, and the leading cause of cancer deaths in Southern Africa amongst women. Despite this, access to prevention, screening and treatment programmes are inadequate in the region, leading to high levels of preventable death and unnecessary illness and suffering. In 2012, just over half a million new cases of cervical cancer were diagnosed and 266 000 women died of the disease, with 90% of them living in low- and middle income countries.
A 2012 report on cervical cancer and human rights in Southern Africa describes cervical cancer as “a disease of inequality and poverty.” Poor women, women living in rural areas, women and girls living with HIV and other marginalised women are at heightened risk of cervical cancer and are less likely to have access to comprehensive prevention, screening and treatment services.
Cervical cancer is a largely preventable and treatable form of cancer, especially if diagnosed early. A key part of cervical cancer prevention is the Human Papilloma Virus (HPV) vaccination, administered to adolescent girls. Screening for cervical cancer is important for all women, but it is particularly important for women and girls living with HIV. Women and girls living with HIV are four to five times more likely than HIV-negative women and girls to get cervical cancer, which has been recognised as an AIDS defining illness. Unfortunately, countries with high levels of HIV are often those with insufficient cervical cancer programming. Access to cervical cancer prevention, screening and treatment are part of a comprehensive package of sexual and reproductive health care and the failure to provide them undermines the SRHR of women, including those living HIV.
International and regional human rights obligations
SADC countries have international and regional human rights obligation to provide effective prevention and treatment services for cervical cancer. These include the right to life, the highest attainable standard of health, to equality and non- discrimination and access to information. The Southern African Litigation Centre concluded that these “legal obligations … require countries to issue and implement national policies on comprehensive cervical cancer management; ensure women have full information on cervical cancer; make available and provide access to prevention, screening and treatment services for cervical cancer and make provision for palliative care for women with advanced cervical cancer.”
Key components of a comprehensive approach to cervical cancer
Prevention
Prevention is an essential part of a cervical cancer programme and there are both primary and secondary prevention measures:
• Primary prevention revolves around preventing HPV infection. The HPV vaccine has been proven to significantly reduce the burden of cervical cancer and the WHO recommends that the vaccine be given to adolescent girls between the ages of 9 and 13 because it is most effective if administered before girls become sexually active; and
• Secondary prevention focusses on screening and detection of cervical cancer and the treatment of pre-cancerous lesions. This is done through a pap smear and the WHO recommends that in resource poor settings, pap smears are given to women at the age of 30, and then every three years.
Access to cheaper HPV vaccines
Gavi, the Vaccine Alliance, is a public–private partnership that has brought about significant reductions in the cost of HPV vaccines, which are now available in developing countries for about US$ 4.50 per dose (compared to US$100 in developed countries). Gavi have planned to support more than 20 countries to vaccinate approximately one million girls with HPV vaccines through demonstration projects by 2015. By 2020, more than 30 million girls are expected to have been vaccinated in more than 40 countries through Gavi support.
Diagnosis
If abnormal results are obtained after a pap smear, additional tests must be done to determine the extent of the pre-cancer or cancer.
Treatment
There are various options available for the treatment of pre-cancerous lesions and cancer.
• Pre-cancer: there are two treatments for pre-cancerous lesions, which both involve the removal of the abnormal tissue. One involves the freezing off of the area through a process called cryotherapy or the removal of the tissue using loop electrosurgical excision procedure (LEEP). Cryotherapy is appropriate for low resource settings because it does not require anaesthetic and it can be performed by primary health care workers if they have been adequately trained and are appropriately supervised; and
• Cancer: the earlier that cervical cancer is diagnosed, the better the chance of survival. There are various treatment options, depending on the stage of the cancer. These include hysterectomy, chemotherapy and radiation.
Palliative care
Palliative care provides pain relief and addresses the end of life needs of patients and their families.
Women living with HIV and cervical cancer
Women living with HIV are more susceptible to cervical cancer and are more likely to be infected with the HP virus.73 Women with HIV are more likely to develop pre-cancerous lesions that, if not treated, will quickly progress to cervical cancer. The WHO recommends screening and providing adequate treatment to all women living with HIV as soon as they know their status and if they are or have been sexually active.
Human rights barriers to comprehensive cervical cancer prevention, screening and treatment
The 2012 Southern Africa Litigation Centre report on cervical cancer in Southern Africa concluded that very few SADC countries are effectively addressing cervical cancer, with few having comprehensive cervical cancer policies in place. In order to prevent unnecessary deaths, governments must ensure that women are able to access a comprehensive cervical cancer programme that includes primary prevention, screening, treatment, palliative care and makes adequate provision for the special needs of women living with HIV or those at higher risk of HIV.
The HPV vaccine is not widely available for free in many SADC countries and other barriers to prevention, screening and treatment include a lack of trained health care workers and inadequate laboratory facilities.
In addition to the structural barriers, there are human rights issues that prevent women and girls from accessing care where it is available, including the following:
Lack of information about cervical cancer and misperceptions about the HPV vaccine
Research shows that there are low levels of knowledge about cervical cancer in Southern Africa.
The lack of information amongst women and girls, parents and health care workers, creates obstacles to access services, even if they do exist, and reinforces negative attitudes on the part of health care workers about sexual and reproductive health care. Girls and young women are especially vulnerable to stigma and discrimination when they seek sexual and reproductive health care, including information on cervical cancer. Lack of information particularly undermines prevention efforts which depend on women and communities being aware of, and understanding their risks and what prevention and screening services are available.
Young women and girls also face particular challenges in accessing information about their risk of cervical cancer and HPV infection. There are many misconceptions about the HPV vaccine, including whether it is safe to administer and whether it promotes promiscuity. There are insufficient programmes that target parents and care givers about why it is important to vaccinate girls and the health benefits of the vaccine. Health care workers are often not trained to provide information and care to young women and girls and they lack the necessary skills to support this group of vulnerable women. In addition, age of consent laws may prevent girls from accessing services related to cervical cancer without the consent of their parents or guardians.
Next we continue the discussion on Stigma associated with sexual and reproductive health care, including cervical screening
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