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.
Cervical cancer: this is a form of cancer that begins in the cervix and it is largely caused by the Human Papilloma (HP) virus. It is a slow-growing cancer and in some cases, can take up to 20 years to develop.
Human Papillomavirus (HPV): causes invasive cancer, including cervical cancer and is transmitted through sexual contact. Penetration is not required for transmission of HPV.
HPV vaccine: the vaccine is a form of primary prevention for cervical cancer. The first HPV vaccine was approved in 2006.
Hysterectomy: a surgical procedure (operation) to remove all or parts of the uterus. Palliative care: WHO defines palliative care as “[A]n approach that improves the quality of life of
patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”
Pap smears: this is a form of cancer screening by examining cells under a microscope. Cells are scraped from the cervix and examined for cancer or pre-cancerous changes.
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.”
Joint UN programme on cervical cancer prevention and control
The Programme was launched in May 2016 and will support governments in developing countries to implement functioning and sustainable high-quality national comprehensive cervical cancer control programmes that allow women to access services equitably.
This is in line with the UNAIDS 2016–2021 Strategy, which emphasises that prevention, treatment, care and support services should be integrated with services that address coinfections and comorbidities, and with sexual and reproductive health services.
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.
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
Next, we discuss: Human rights barriers to comprehensive cervical cancer prevention, screening and treatment