Cervical cancer is the leading cause of cancer death among women in southern Africa, but new research reveals that governments’ attempts to address the disease have been inadequate. Access to cervical cancer screening services is minimal, few countries in the region have policies on the disease, and treatment remains a major challenge.
The study, based on regional desktop research and field research in Namibia and Zambia by the Southern Africa Litigation Centre (SALC), assessed the state of cervical cancer services in southern Africa, particularly in Namibia and Zambia, finding that many women access medical assistance only when they have advanced cervical cancer, which is more difficult to treat and can be extremely painful.
"The failure to provide access to cervical cancer services results in the violation of fundamental rights and in the loss of countless lives. There is a serious and urgent need to improve services for cervical cancer in the southern Africa region," the report warned.
The HIV/AIDS epidemic in southern Africa may have contributed to the high number of cervical cancer deaths; women infected with HIV are more likely to develop cervical lesions that can become cancerous.
But there is still a lack of clear and comprehensive national cervical cancer management guidelines and policies in the region. Neither Namibia nor Zambia has comprehensive guidelines on the management of the illness. Where guidance is available, it tends to be inadequate, focusing on screening, with limited guidance about other forms of prevention or treatments.
"The piecemeal approach to addressing cervical cancer in national policies results in inconsistent commitment," the report added.
According to Nyasha Chingore, HIV project lawyer with SALC and the author of the report, Botswana is one of the few countries with a broad, accessible cervical cancer policy. As a result, more women in the country have access to Pap smear screenings - in which a sample of cervical cells is collected and checked for abnormalities. The number of screenings has increased from 5,000 per year before 2002 to 32,000 per year in 2009.
Where there are no policies, or where policies are not easily accessible by health systems, women are not made aware of the services that are available to them. "With HIV, we all know that when you test positive, they must do a viral load test and CD4 count test... Everybody knows the policy. We have material in our support groups. But with this cervix cancer thing, we don’t know what we are entitled to," said a study participant.
The report found "a significant amount of misinformation" in Namibia, where most of the young women interviewed reported being informed - incorrectly - by healthcare workers that contraceptives cause cervical cancer or are a risk factor for the illness.
Stigma is also a major challenge. "It's not an easy topic to talk about. You have to talk about sex, and you develop sores in places no one wants to talk about," Chingore told IRIN/PlusNews.
Access to screenings in Zambia is determined by geographical location, with few if any screening services available outside of the capital, Lusaka. While cervical cancer services seem to be generally available in Namibia, access is limited by factors such as the lack of prioritization of cervical cancer screening by health workers.
|With HIV, we all know that when you test positive, they must do a viral load test and CD4 count test ... Everybody knows the policy ... But with this cervix cancer thing, we don't know what we are entitled to|
Treatment and vaccines
"The treatment of invasive cervical cancer continues to be a major challenge in the region due to the lack of surgical facilities, skilled providers, chemotherapy and radiotherapy services. In Namibia and Zambia, there is a dearth of treatment options, with hysterectomy being the most prevalent form of treatment. There are few treatment options available to women who want to preserve their fertility," the report said.
Because of structural problems, including inadequate laboratory facilities and personnel shortages, patients and health workers often choose treatment options without having proper diagnoses or adequate information, it added.
Two vaccines against the human papillomavirus (HPV) - a sexually transmitted virus that can cause cervical cancer - are currently available, but the cost of the vaccines has made it difficult for countries to introduce vaccination campaigns. "Governments need to think about how to make vaccines easily available... Whether it's through parallel importation or compulsory licensing, there are options, they just need to be explored," Chingore told IRIN/PlusNews.
So far, Zambia and Lesotho are the only countries in the region rolling out free HPV vaccination programmes, the report noted.
In June 2011, Merck announced it would provide the vaccine Gardasil to the Global Alliance for Vaccines and Immunization (GAVI), for US$5 per dose, a reduction of nearly 70 percent. Eligibility for GAVI support, however, is determined by national income; while Lesotho, Malawi, Mozambique, Zambia and Zimbabwe are eligible, Angola, Botswana, Namibia, South Africa and Swaziland are not.
SALC urges southern Africa governments to integrate cervical cancer screening into existing sexual and reproductive health services, to allocate adequate resources to the management of cervical cancer, and to establish cancer registries to assess the impact of cervical cancer screening programmes.